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:

August 2006

Health Care Employers Required to Educate Employees on False Claims Act Whistleblowing

by Nolan and Auerbach on August 30, 2006

Employee Section 6032 “Employee Education About False Claims Recovery” requires that entities receiving or making more than $5 million in annual payments under a state Medicaid plan, must,  as a condition of participation, create written compliance policies designed to educate employees, contractors and agents about false claims, false statements and whistleblower protections under applicable federal [...]

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South Carolina Medical Center to Pay $3.75 Million Fine

by Nolan and Auerbach on August 23, 2006

As a result of violating Stark Laws and submitting improper bills to Medicare, Medicaid and TRICARE, the Marion County Medical Center in South Carolina will pay $3.75 Million arising out of a qui tam False Claims Act case filed by a whistleblower. For more information click here.

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False Certification Case Settled for $9 million

by Nolan and Auerbach on August 10, 2006

This case settlement is a recent example of false claims act liability based upon false certification. Although this is not a healthcare fraud case, we point out that false certification in the healthcare fraud field is still probably going strong and the basis for liability. To see a brief story, click here.

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Medicare Fraud – Motorized Wheelchairs

by Nolan and Auerbach on August 8, 2006

An Arkansas physician was sentenced to prison for his role in a Medicare fraud case involving motorized wheelchairs. The physician convinced his elderly patients to seek motorized wheelchairs which were paid for with Government funds. The wheelchair supplier was allegedly paid kickbacks as part of the scheme. For more information,  click here.

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Qui Tam Lawsuits Stike Hard at Healthcare Fraud

by Nolan and Auerbach on August 3, 2006

A new Taxpayers Against Fraud Report confirms the success of the Qui Tam provisions of the False Claims Act in fighting health care fraud. To see the full Report, click here.

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