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:

June 2009

Inspector general addresses health care fraud

by Nolan and Auerbach on June 26, 2009

On Thursday, June 25, 2009, Daniel R. Levinson presented testimony on the Office of the Inspector General’s (OIG’s) role in addressing health care waste, fraud and abuse, as well as its plans for health care reform. Talking before the Subcommittee on Health of the House Energy and Commerce Committee Levinson, inspector general of the U.S. [...]

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Miamians Charged in Elaborate Medicare Fraud

by Nolan and Auerbach on June 24, 2009

Federal prosecutors charged eight conspirators in Miami with defrauding the U.S. healthcare system by creating phony clinics that churned out $100 million of medical bills in five states, according to a June 23, 2009 Reuters news article. The sophisticated scheme involved fake clinics, which in reality were empty storefronts or post office boxes–none providing any [...]

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Double-billing Settlement Highlights Whistleblower Concerns

by Nolan and Auerbach on June 23, 2009

Earlier this week, the University of Medicine and Dentistry of New Jersey agreed to pay the federal government $2 million to settle a whistleblower lawsuit alleging that it bilked Medicaid in a double-billing scheme that started in 1993 and ended in 2003, according to the Department of Justice. The settlement was the second time UMDNJ [...]

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UMDNJ to Pay U.S. $2 Million for Allegations of Medicare Fraud

by Nolan and Auerbach on June 9, 2009

The University of Medicine and Dentistry of New Jersey (UMDNJ) has agreed to pay the United States $2 million to resolve federal civil fraud allegations that its hospital defrauded Medicaid, the Justice Department announced June 9, 2009, according to a press release on PR Newswire. From 1993 to 2004, UMDNJ’s University Hospital submitted claims to [...]

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