Medicare Fraud News, Breaking Headlines and Insight from the Qui Tam Perspective
From the category archives:
Outlier payments are reimbursements by the Medicare program to compensate hospitals for extraordinarily costly inpatient cases, as compared to average or typical costs incurred in connection to inpatient care. Congress intended these payments to compensate hospitals only for treating inpatients whose care involves extraordinarily high costs. The Medicare program relies on hospital-reported charges, adjusted to [...]
{ 0 comments }
The federal government has been increasingly saber-rattling about its intention to criminally prosecute high-level executives who steer pharmaceutical and medical device makers into fraudulent waters. A few days ago, the federal government followed through on its tough words, when it obtained a guilty plea from a former vice president of a medical device company for [...]
{ 0 comments }
A CMO overpayment fact pattern recently came to light in an intervened False Claims Act qui tam case against WellCare Health Plans, Inc. In this case, Wellcare paid $137.5 million to quiet allegations that it falsely inflated the amount it claimed to be spending on medical care in order to avoid returning money to Medicaid [...]
{ 0 comments }
As the generational wave of baby boomers flows into the Medicare program in the coming years, the pool of government funds exposed to fraudulent schemes will swell. In response, the federal government is increasingly securing the walls of the Medicare Trust Fund, looking for health care fraudsters who are illegally draining Medicare dollars. These actions [...]
{ 0 comments }
Government Healthcare Programs only pay for claims for hospital admissions that are medically necessary. Claims for one-day inpatient stays that are not medically necessary are ineligible for payment and therefore “false” under the False Claims Act. Much to the chagrin of wayward hospitals, the federal government is increasingly targeting hospitals with disproportionately high one-day stay [...]
{ 0 comments }
On a regular basis, HHS-OIG releases the results of its audits, examining the high rate of overpayments by Medicare contractors. Oftentimes, the Reports include general recommendations and admonishments about how the government should do a better job policing Medicare contractors to avoid overpaying them. Dishonest healthcare providers oftentimes engaged in a “finders’ keepers” approach to [...]
{ 0 comments }
Diakon Hospice, one of the oldest hospices in Pennsylvania, recently paid nearly $11 million to the Federal Government, related to submitting Medicare claims for beneficiaries who were not eligible for hospice benefits under the Medicare regulations. Diakon had voluntarily disclosed the problem to the Government. By voluntarily stepping forward, Diakon may have avoided a government [...]
{ 0 comments }
Recently, the U.S. Supreme Court declined to review a federal appeals court ruling in a closely watched case over whether a defendant can be held liable under the False Claims Act for “causing” health care providers to submit Anti-kickback Statute-violative Medicare claims (Blackstone Medical Inc. v. United States ex rel. Hutcheson, U.S., No. 11-269, review [...]
{ 0 comments }
Congressman Chaka Fattah (D-PA) issued a statement today, as the “top Democratic appropriator” for the Department of Justice: “The Justice Department under Attorney General Eric Holder’s leadership just announced that it has recovered a three-year record of nearly $9 billion for fraudulent claims against the government. A huge amount of that recovery is for healthcare [...]
{ 0 comments }
Whether through omission or commission, health care providers regularly overbill Government Health Care Programs. This message has been echoed, time and time again, in audit reports from the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). In the most recent audit report, HHS-OIG found that the audited providers overbilled Medicare 75% [...]
{ 0 comments }
