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:

October 2006

Home Health Care Industry Riddled With Fraud

by Nolan and Auerbach on October 30, 2006

Marietta Diaz, a former employee of Provident Health Care filed a whistleblower lawsuit against her former employer. Diaz claimed that Provident Home Health Care Services, Inc. and Tri-Regional Home Health Care Inc. billed Medicare for home health services that were never provided. Los Angeles Assistant U.S. Attorney Consuelo Woodhead said that this case is not [...]

{ 0 comments }

CMS Steps Up Efforts to Ferret Out Fraud -Southern Florida is mentioned

by Nolan and Auerbach on October 24, 2006

CMS recently announced multiple accomplishments and projects, all designed to reduce fraud and abuse: the Los Angeles office of CMS revoked the billing numbers of 117 providers who had presented false claims or suspicious business operations, saving $200 million, editing the system to stop payment on claims using billing numbers from deceased providers saved another [...]

{ 0 comments }

California Home Health Care Provider Pays $33.8 Million to Settle Medicare Fraud Claims

by Nolan and Auerbach on October 16, 2006

In one of the largest Medicare fraud cases in California history, the owner of Tri-Regional Home Health Care and Provident Home Health Services cheated Medicare of approximately $40 million through a network of paid recruiters and falsification of documents. A payroll clerk working for the company filed a qui tam action in the case after [...]

{ 0 comments }

Dr. Comfort Shoes in an $18 Million Tight Squeeze

by Nolan and Auerbach on October 10, 2006

Dr. Comfort Shoes (also known as Rikco International LLC) cannot be feeling too comfortable these days. In March of this year, FBI agents executed a search warrant which was unsealed this week, alleging the company located in Mequon, Wisconsin, cheated Medicare of millions of dollars by claiming diabetic shoes and inserts were approved by Medicare [...]

{ 0 comments }

Pediatrix Pays $25 Million for False Billings for Neonatal Critical Care when Patients not Critically Ill

by Nolan and Auerbach on October 9, 2006

Pediatrix Medical Group, Inc., a network of physician groups who provide medical services in hospital neonatal intensive care units in 32 states has agreed to pay the government over $25 million to settle government claims under the False Claims Act that Pediatrix improperly billed and upcoded reimbursement claims for more expensive treatment than actually provided. [...]

{ 0 comments }