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:

January 2010

National Dental Management Company Pays $24 Million to Resolve False Claims Act Allegations

by Nolan and Auerbach on January 24, 2010

The United States has settled False Claims Act allegations against FORBA Holdings LLC, a dental management company that provides business management and administrative services to 69 clinics nationwide known as “Small Smiles Centers.” Under the agreement, FORBA will pay the United States and participating states $24 million, plus interest, to resolve allegations that it caused [...]

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Medicare Fraud Strike Force Charges 30 Individuals with Medicare Fraud and Expands Operations

by Nolan and Auerbach on January 12, 2010

Thanks to the Medicare Fraud Strike Force, 30 people have been charged in three cities for their alleged roles in schemes to submit more than $61 million in false Medicare claims, according to a Dec. 15, 2009 press release by the Federal Bureau of Investigation (FBI). These individuals who were charged are accused of various [...]

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Spectranetics Corporation to Pay $5 Million to Resolve Allegations of Health Care Fraud

by Nolan and Auerbach on January 7, 2010

Spectranetics Corporation, a medical device manufacturer, has agreed to pay the United States $4.9 million in civil damages, as well $100,000 forfeiture to resolve claims against the company, the United States Department of Justice (DOJ) announced December 29, 2009. The claims arise from allegations that the company illegally imported unapproved medical devices and provided them [...]

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Texas Hospital to Pay U.S. Nearly $1 Million for Allegations it Violated the False Claims Act

by Nolan and Auerbach on January 7, 2010

Arlington Memorial Hospital, Arlington, Texas, has agreed to pay the U.S. $990,509.50 to resolve allegations that it violated the civil False Claims Act, according to a Jan. 4, 2010 announcement by U.S. Attorney James T. Jacks of the Northern District of Texas. The Texas hospital allegedly violated the civil False Claims Act by submitting improper [...]

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