Medicare Fraud News, Breaking Headlines and Insight from the Qui Tam Perspective
From the monthly archives:
Earlier this week, the federal government unveiled proposed regulations to crack down on Medicare and Medicaid fraud by empowering government officials with the power to stop payments as soon as credible fraud allegations are made. Currently, improper health care payments continue to pour out of the federal government coffers, even when credible allegations have been [...]
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According to a Securities and Exchange Commission filing, WellCare Health Plans has agreed to pay $137.5 million to settle a False Claims Act qui tam action, claiming that the Medicare and Medicaid contractor stole $400 million to $600 million from government health care programs in several states. The whistleblower alleges that the company avoided paying [...]
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The federal government in part relies on private contractors, known as recovery audit contractors (RACs), to detect fraudulent activity targeting the Medicare systems. Recently, the federal government, through its agency the Center for Medicare & Medicaid Services, decided to expand one RAC’s auditing powers to include medical necessity reviews. These intensive audits are designed to [...]
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In 2007, the federal government overpaid health care providers by an estimated $14 million because Medicare claims contained erroneous place-of-service codes, according to an HHS-OIG report. Medicare reimburses providers at a higher rate for services provided in a non-facility setting, such as a physician’s office or an independent clinic. This higher reimbursement rate helps to [...]
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Three Philadelphia-area hospitals self-disclosed to the government that on several occasions, they had improperly billed Medicare for “one-day inpatient hospital admissions” which should have been billed as “observations” or “outpatient visits.” The hospitals agreed to pay the government a total of $7.9 million to resolve concerns about the miscoded claims. This is an emerging area [...]
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St. John’s Health Center, of Santa Monica, California, has agreed to pay the federal government $5.25 million to settle allegations that it sought inflated Medicare “outlier” payments. These payments are only intended for extraordinarily expensive medical care, and are not intended to reimburse the hospital for routine procedures. By allegedly turbo charging–raising its charges more [...]
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