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.

Calif. County to Pay U.S. $6.8 Million for Allegations of False Medicare, Medicaid Claims

by Nolan and Auerbach on March 18, 2009

The U.S. Department of Justice announced March 12, 2009, that San Mateo County, Calif., will pay the United States $6.8 million to resolve allegations that the San Mateo Medical Center (SMMC) submitted false claims to the United States in connection with payments from the Medicare and Medicaid programs.

The government alleges that SMMC engaged in Medicare Fraud by falsely inflated its bed count to Medicare in order to receive higher payments under Medicare’s Disproportionate Share Hospital (DSH) adjustment. The government also alleges that San Mateo County improperly obtained federal payments under the Medicaid program for services provided to patients at Institutes of Mental Disease (IMDs) who were between the ages of 22 and 64. This is once again an example of a case where the simple manipulation of a few numerals results in overpayments of millions of dollars. The lawsuit was filed under the qui tam or whistleblower provisions of the False Claims Act by a former employee of San Mateo County.

For a copy of the full press release, http://www.usdoj.gov/opa/pr/2009/March/09-civ-224.html. For more information about qui tam whistleblower law, contact Nolan and Auerbach, PA.

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