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.

California Home Health Care Provider Pays $33.8 Million to Settle Medicare Fraud Claims

by Nolan and Auerbach on October 16, 2006

In one of the largest Medicare fraud cases in California history, the owner of Tri-Regional Home Health Care and Provident Home Health Services cheated Medicare of approximately $40 million through a network of paid recruiters and falsification of documents. A payroll clerk working for the company filed a qui tam action in the case after she observed envelopes stuffed with cash and was asked to fill out customer satisfaction surveys for home care that was never provided. In addition, the whistleblower alleged that her employer hired marketers to recruit patients for home health services whether they needed it or not. Doctors were allegedly paid for referrals, and recruiters were paid up to $400 for each enrolled patient.

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