Medicare Fraud

Rex Healthcare, of North Carolina, has agreed to pay $1.9 million to settle allegations that it fraudulently charged Medicare by improperly classifying patients for inpatient services. By classifying patients as inpatients the hospital would receive a larger reimbursement from Medicare than if they had been classified as outpatient. Hospitals that make false claims for larger [...]

{ 0 comments }

Currently, state Medicaid Fraud Control Units (MFCUs) have limited resources and capabilities to use statistical models and data mining technologies to identify patterns of health care fraud. These limitations have appeared even when whistleblowers have successfully uncovered possible widespread fraudulent business practices. However, this all might soon change under a recently proposed federal rule. The [...]

{ 0 comments }

Our Medicare system relies on contractors to identify fraudulent claims from the Durable Medicare Equipment (DME) industry. However, time and time again, Medicare contractors have dropped the ball when it comes to identifying even the most egregious instances of fraud. To fully protect our Medicare dollars, the Medicare system has regularly turned to whistleblowers and [...]

{ 0 comments }

Inpatient rehabilitation facilities receive higher Medicare reimbursement payments when patients are discharged, than when the patients are transferred to other facilities. However, according to a recent HHS-OIG report, some facilities have a “difficult time” distinguishing between discharged and transferred patients. In this audit, HHS-OIG reviewed the records of 41 inpatient rehabilitation facility patients who were [...]

{ 0 comments }

Medical device-maker Kyphon allegedly trained its sales force to coach hospitals how to improperly schedule and bill kyphoplasty as an inpatient procedure. By billing as an inpatient procedure, the hospitals were able to wrongfully obtain additional government health care dollars for inpatient care that was typically a 1- 2-hour day surgery. After two Kyphon exposed [...]

{ 0 comments }

Nolan & Auerbach, P.A. Managing Partner Marcella Auerbach will speak at the University of Miami 2011 Law Review Symposium on Friday February 18, 2011. Ms. Auerbach will discuss the topic of health care fraud during the opening panel discussion. She will be joined in her health care fraud panel by David Hyman, Richard W. and [...]

{ 0 comments }

Two St. Louis-based hospital systems have agreed to shell out more than $2.2 million to quiet allegations that they submitted false Medicare claims for routine foot care procedures. Under the terms of the settlement, St. John’s Mercy Health System and St. John’s Health System have agreed to close the foot clinics and to pay the [...]

{ 0 comments }

While investigating a doctor who reportedly implanted hundreds of potentially medically unnecessary stents, Senate investigators may have stumbled across a troubling nationwide practice that drains funds from government health care programs and needlessly places patients’ lives at risk. In their released report, Senate Finance Committee Chairman Max Baucus (D-Mont.) and Ranking Member Chuck Grassley (R-Iowa) [...]

{ 0 comments }

Last year, Congress amended the federal False Claims Act to close a “finders’ keepers” loophole, which had permitted health care providers to keep Medicare and Medicaid overpayments. Earlier this year, as part of the Health Care Reform Legislation, Congress set a 60-day time limit for providers to return these overpayments. Specifically, Section 6402 of the [...]

{ 0 comments }