Medicare Fraud

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 [...]

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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 [...]

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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 [...]

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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% [...]

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Ancillary revenue streams of physician practices, for example the technical component fees of MRIs, CT scans, etc, are valuable to hospital systems. Hospitals have packaged together compensation packages for physician groups that they simply could not refuse. However, to tiptoe around the Stark and Anti-kickback laws, they have structured these arrangements with fixed payouts, which [...]

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From patient enrollment to equipment delivery, every single stage of the DME supply process has fallen under the False Claims Act microscope. Increasingly, the government has zeroed in on what we call “set it and forget it” Medicare billing schemes. Here, the DME supplier appropriately approves a Medicare beneficiary to receive a particular DME. However, [...]

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The current political debate in Washington centers on whether to cut government spending. However, with over $110 billion in improper or erroneous payments flowing out of the government’s coffers in 2010, the real focus should be on cutting improper government spending. Most importantly, increased scrutiny should be directed at improper government health care spending, which [...]

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In 2009, Congress made an important improvement to the False Claims Act, expanding the “Reverse False Claims” provision to reach those who consciously retain an overpayment of government funds. The impact of this amendment will not be realized for years, but the potential size of the overpayment iceberg is truly remarkable. For example, an FY [...]

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While the pharmaceutical industry is gradually changing its wayward ways, certain durable medical equipment (DME) counterparts are still cemented in a culture of deceit. This message was, once again, echoed in a scathing HHS-OIG report, Most Power Wheelchairs in the Medicare Program Did Not Meet Medical Necessity Guidelines (OEI-04-09-00260). According to an HHS-OIG investigation of [...]

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