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 2007

Scooter Store Gets Caught Scooting Medicare

by Nolan and Auerbach on May 25, 2007

In order to settle allegations that the Scooter Store submitted false claims to Medicare, the New Braunfels, Texas company agreed to pay the federal government $4 million and forego another $13 million in Medicare payments. The payments resolve several lawsuits including a whistleblower complaint from a former Scooter Store employee.  The whistleblower will receive $3.2 [...]

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Has Greed Driven Stent Implantation?

by Nolan and Auerbach on May 17, 2007

The FBI is apparently investigating allegations that a Maryland cardiologist, Dr. John “Jack” McLean was performing unnecessary stent implantations on his patients.  Officials have stated that most of the patients involved are Medicare patients.  On average, Medicare pays between $11,184 to $14,287 for a drug-eluting stent procedure. The investigation which involves the FBI as well [...]

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