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.

$60 Million Settlement by CoxHealth (Lester E. Cox Medical Centers) for Healthcare Fraud

by Nolan and Auerbach on November 4, 2008

Improperly billed claims paid by Medicaid payments has resulted in a $60 million settlement by CoxHealth. This settlement resulted from allegations that beginning as far back as January 1996, CoxHealth allegedly entered into prohibited financial agreements that violated Medicare cost report requirements, Stark Laws and the Anti-Kickback Statute. John F. Wood, the U.S. Attorney for the Western District of Missouri who brought the case said, “Our priority is protecting the patients. These laws are intended to ensure that physicians make referrals to health care facilities based on the best interest of their patients without being induced by payments from hospitals competing for their business. These laws also protect the integrity of the government-funded health care benefit programs.” These laws are in place to make sure that patient care is not compromised and that the best interest of the patient is paramount.

To read more about this case, click here. Contact Nolan & Auerbach P.A. for more information about healthcare fraud.

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