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.

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 combating Medicare Fraud. The government will also expand Strike Force team operations to in some high-risk fraud areas to fight Medicare fraud on a targeted local level.

Fraud prevention efforts are also strengthened in President Obama’s proposed Fiscal Year 2010 budget. The President’s budget invests $311 million – a 50 percent increase from 2009 funding – to strengthen program integrity activities within the Medicare and Medicaid programs. Combined, the anti-fraud efforts in the President’s budget could save $2.7 billion over five years by improving oversight and stopping fraud in the Medicare and Medicaid programs, including the Medicare Advantage and Medicare prescription drug programs, according to the announcement.

To read the full release, go to: US DOJ For more information about Qui Tam law and health care fraud, contact Nolan and Auerbach, PA.

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