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 2009

Alleged False Claims Act Violations Land Minnesota Hospitals in Hot Water

by Nolan and Auerbach on May 22, 2009

Three HealthEast Care System hospitals have agreed to pay the United States $2.28 million to settle allegations that the health care facilities submitted false claims to Medicare, the U.S. Justice Department announced May 21, 2009. According to the DOJ press release, the settlement resolves allegations that the St. Paul, Minn.-based hospitals overcharged Medicare from 2002 [...]

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Texas-Based Nursing and Rehabilitation Centers to Pay U.S. $4 Million for Alleged False Medicare and Medicaid Billings

by Nolan and Auerbach on May 21, 2009

Regency Nursing and Rehabilitation Centers Inc. nursing home chain will pay the United States $4 million to settle allegations that Regency submitted false claims to Medicare and the Texas Medicaid program, the Justice Department and the U.S. Attorney’s Office for the Southern District of Texas announced May 21, 2009. The Victoria, Texas-based chain currently owns [...]

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Attorney General and HHS Secretary Announce New Interagency Health Care Fraud Prevention and Enforcement Action Team

by Nolan and Auerbach on May 21, 2009

The government has created a new interagency health care fraud prevention and enforcement team, according to a May 20, 2009 announcement by Attorney General Eric H. Holder, Jr. and Health and Human Services (HHS) Secretary Kathleen Sebelius. The new interagency effort, called the Health Care Fraud Prevention and Enforcement Action Team (HEAT), is charged with [...]

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Homecare Association Presents 13-point Plan to Eliminate Medicare Waste, Fraud and Abuse

by Nolan and Auerbach on May 7, 2009

In April 2009, the American Association for Homecare presented Congress with its 13-point legislative action plan, called the Medicare Anti-Fraud Legislative Plan, aimed at eliminating waste, fraud and abuse in Medicare’s home medical equipment sector. The plan’s steps, according to the homecare association, would eliminate most of the Medicare fraud attributed to the home medical [...]

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Wellcare to Pay $80 Million in Medicaid Fraud Case

by Nolan and Auerbach on May 6, 2009

Executives and employees at WellCare Health Plans Inc. engaged in an elaborate scheme to defraud the Florida Medicaid program and the Florida Healthy Kids Corporation, according to a press release by the U.S. Department of Justice. In order to avoid a health care fraud conviction on these charges WellCare must, among other things, consent to [...]

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