Medicare Fraud

Every year, we lose billions of dollars to fraud in federal and state health care programs. Every dollar we lose to fraud and abuse is a dollar that is not available to provide home care to seniors, to treat HIV and AIDS, to immunize children, and to discover new treatments for cancer and other diseases. Some fraud schemes even pose a direct threat to the health and safety of patients. Many instances of health care fraud sug­gest that existing control systems do not work the way we imagine they should. Often the manner in which schemes are revealed suggests detection is more luck than system. Whistleblower lawsuits have exposed billing by health care providers for services not rendered, billing for products not delivered, misrepresenting services, unbundling services, billing for medically unnecessary services, duplicate billing, increasing units of service which are subject to a payment rate, falsifying cost reports resulting in increased payment to the health care provider, kickbacks, and on and on. Healthcare fraud is still going strong and this blog is intended to keep readers up to date with all healthcare fraud related news and to provide commentary when warranted. This blog also contains an array of laws and regulations concerning healthcare fraud set out in an easy to read format.

From the monthly archives:

May 2006

Stark Violations Land Hospital in Hot Water

by Nolan and Auerbach on May 10, 2006

A May 9, 2006, Los Angeles Times article (Lisa Girion, U.S. Programs May Exclude Tenet Hospital, The Los Angeles Times, May 9, 2006 at C9), it was reported that, “… the Department of Health and Human Services’ Office of Inspector General notified Dallas-based Tenet that it intended to exclude Alvarado Hospital Medical Center in San [...]

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Stark Violations May Result in Exclusion of Tenet Hospital from Federal Programs

by Nolan and Auerbach on May 10, 2006

The “Stark” statute, 42 U.S.C. §1395nn, is also known as the Physician Self-Referral Law or Section 1877 of the Social Security Act. The Stark law was intended to prevent physicians from profiting (actually or potentially) from their own referrals. The Stark statute acts prospectively, i.e., it prohibits relationships that have been demonstrated to encourage over-utilization. [...]

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Something to Hide? Big Pharma Attorneys Say “No” to False Claims Act

by Nolan and Auerbach on May 10, 2006

The pharmaceutical industry is attempting to curtail the success of the federal False Claims Act by discouraging its application and expansion to additional states. While big pharma lawyers argue that these cases are nothing more than a “lottery ticket,” Jill Kozeny, Senator Grassley’s spokeswoman, attributes the recovery of “billions of dollars that would have been [...]

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Big Fines Levied For Violations of False Claims Act

by Nolan and Auerbach on May 10, 2006

In an article that appeared in The Baltimore Sun (Jonathan D. Rockoff, Improper sales of medicines targeted; Drug firms have paid fines of $3.5 billion since 2001 for wrongful promotions, The Baltimore Sun, May 7, 2006 at 1A), it is reported that since 2001, pharmaceutical companies prosecuted under the False Claims Act have paid nearly [...]

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