A dishonest hospital submits false cost reports to the Medicare program by representing that its costs associated with inpatient medical care were higher than they actually were. In other words, through a scheme commonly called “turbocharging,” a hospital manipulates its charge structure to make it appear as though its treatment of certain inpatients was extraordinarily costly, which in fact it was not.  The end result is that the hospital receives millions of Medicare outlier payments that it would not have received if it had not implemented these charge increases.

This alleged Medicare fraud was most recently exposed in an $11.75 million False Claims Act settlement involving Lenox Hill Hospital. According to the government’s complaint, the hospital obtained increased outlier payments by falsely padding its costs, such that the reported charges “no longer reasonably reflected or approximated Lenox Hill’s actual costs.”

More information for whistleblowers is located at the Nolan & Auerbach, P.A. website.

According to criminal information, in 2007, the unnamed surgeon became concerned that he had never completed paperwork relating to the consulting arrangement, and he instructed Guerrieri and another company official to create and backdate time sheets, describing tasks that the surgeon had not performed.

Of particular note, Orthofix currently faces civil litigation under the False Claims Act pending before the same court, and under the terms of the plea agreement, Guerrieri has promised to cooperate with the government.

More information for whistleblowers is located at the Nolan & Auerbach, P.A. website.

More information for whistleblowers is located at the Nolan & Auerbach, P.A. website.

Huge recoveries were spotlighted in a recent report on the Health Care Fraud and Abuse Control (HCFAC) program. The HCFAC program was created by the Health Insurance Portability and Accountability Act of 1996, and it is jointly run by HHS and DOJ, with the goal of coordinating federal, state, and local law enforcement activities surrounding health care fraud.

According to the report, the HCFAC program has been responsible for recovering over $21 billion since 1997. The report also revealed that DOJ set records by filing criminal charges against 1,430 defendants and convicting 743 health care fraud defendants in fiscal 2011. Medicare fraud will continue to account for the highest drain on taxpayer dollars.

More information for whistleblowers is located at the Nolan & Auerbach, P.A. website.

Much to the chagrin of wayward hospitals, the federal government is increasingly targeting hospitals with disproportionately high one-day stay rates. Indeed, the government is routinely intervening in False Claims Act qui tam cases founded on fraud allegations, and/or otherwise recouping monies based upon solid evidence that inpatient stays that lacked the requisite medical necessity.

For example, in December 2007, St. Joseph’s Hospital in Atlanta, Georgia, agreed to pay $22 million to settle allegations concerning lack of medical necessity for certain one-day hospital admissions. Similarly, twenty-five other hospitals settled FCA actions in the last four years, quieting allegations that they improperly admitted patients. Most recently, HHS-OIG targeted Beth Israel Deaconess Medical Center, when it subpoenaed documents evidencing impermissible short stays.

More information for healthcare fraud whistleblowers is located at the Nolan & Auerbach, P.A. website.

Dishonest healthcare providers oftentimes engaged in a “finders’ keepers” approach to the receipt of Medicare overpayments. Remarkably, until the False Claims Act Amendments of 2009, the False Claims Act was largely ineffective in reaching those billing practices. Now that the liability loophole has been closed, providers cannot simply turn a blind eye and pocket Medicare overpayments.

In the wake of the 2009 legislation, providers must promptly and fully report, explain, and return all overpayments within sixty days of identifying the erroneous payment. Now that the government and potential whistleblowers are armed with a fully loaded False Claims Act, the time is ticking for dishonest healthcare providers who wrongfully retain overpayments of Medicare and Medicaid funds.

For more information about qui tam law and Medicare fraud, contact Nolan and Auerbach, P.A.

Hospice care, which offers emotional, physical, and spiritual care in addition to end-of-life palliative care to terminally ill patients, is covered under Medicare Part A, under very specific conditions. False Claims Act violations arise when hospices violate these conditions and purposefully submit ineligible claims for reimbursement. For example, a hospice provider potentially runs afoul of the FCA when it submits claims for services that are ineligible for reimbursement, misrepresents the conditions of patients, or misrepresents the purpose of hospice services to patients and their families in order to maintain their admission status for hospice care.

For more information about qui tam law and Medicare fraud, contact Nolan and Auerbach, P.A.

Certainly, this sends another powerful message to wayward drug and medical device companies that they cannot bribe their way into the medicine cabinets of Medicare beneficiaries.

For more information about qui tam law and Medicare fraud, contact Nolan and Auerbach, P.A.

“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 and Medicare fraud. Justice is going after the drug companies, phony equipment purveyors and all those who prey on the sick and the elderly while stealing from the government that insures them ….. [o]n the House Appropriations Committee we are committed to providing Justice and other federal departments involved in this critical recovery effort with the resources they need to fight for the taxpayers against the fraudsters.”

We believe that nearly all of the $9 billion recovery no doubt originated with Medicare fraud qui tam whistleblowers. We applaud the Congressman’s enthusiasm and support of funding for anti-fraud efforts within the Department of Justice and its supporting law enforcement agencies. Funding for anti-fraud efforts has resulted in over ten times the return to the Government, according to past Taxpayers Against Fraud Reports.

For more information about qui tam law and Medicare fraud, contact Nolan and Auerbach, P.A.

In the most recent audit report, HHS-OIG found that the audited providers overbilled Medicare 75% of the time. In a sample size of 1,290 line item payments involving Medicare outpatient services from January 2006 through June 2009, providers improperly billed Medicare 969 times, for more expensive treatments and for unallowable services.

Interestingly, the Medicare contractor that processed these claims did not flag a single improper payment. In other words, all 969 improper claims sailed through the payment system without a single denial or demand for refund. Indeed, these wrongful claims only came to light during the HHS-OIG claim-by-claim audit. The Medicare System needs courageous whistleblowers to step forward and fill this protective void by identifying Medicare fraud. Otherwise, our Government Health Care Programs are in jeopardy.

For more information about qui tam law and Medicare fraud, contact Nolan and Auerbach, P.A.