Medicare Fraud

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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Recently, HHS-OIG was asked to examine a proposed business plan, in which post-acute care providers would pay money to a for-profit online referral service. Under this business arrangement, healthcare providers, such as nursing homes and home health facilities, would pay a fee to electronically receive and respond to referral requests from hospitals. This fee would [...]

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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 [...]

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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 [...]

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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 [...]

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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 [...]

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