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:

September 2006

Medicare Recipient Gets $18,000 Bill for Services Not Rendered Including Infusion Therapy

by Nolan and Auerbach on September 27, 2006

A sharp Medicare beneficiary says that Medicare was billed $24,653 and paid $17,956 for services not provided. The billings included 15 office visits and $1,000 injections for HIV and AIDS patients; neither of which the beneficiary needed or received. As a matter of fact, he had never been to the West Miami medical center that [...]

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CMS Administrator Mark McClellan Is Leaving to Join Think Tank

by Nolan and Auerbach on September 7, 2006

In five weeks, CMS Administrator Mark McClellan is going to leave and focus on improving the health care system in the United States. McClellan is leaving a post he held since March 2004. Previously he was the FDA Commissioner from 2002 through 2004. As part of his job McClellan oversees a federal budget of approximately [...]

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