The suit, originally filed under the qui tam provisions of the FCA, alleges that St. Jude made illegal payments to physicians, hospitals, and other health care providers to induce them to prescribe its medical products, including pacemakers and implantable cardioverter defibrillators. Specifically, St. Jude used post-market studies and device registries as mechanisms to pay physicians illegal kickbacks for using its products. The suit also alleges improper payments to physicians for entertainment and travel, including trips to luxury resorts and tickets to sporting events. The lawsuit contends these payments were illegal kickbacks, in violation of the False Claim Act and the Medicare-Medicaid Anti-Kickback Act.

In its motion in support of its motion for intervention, the government stated that it “found good cause to allege that St. Jude caused the submission of false claims by using four post-market programs – the AWARE, ASSIST, and HOUSECALL PLUS studies, and the ACT registry – as kickback vehicles.” The Government plans to file its own complaint by the end of the month.

The whistleblower in this case is represented by Nolan and Auerbach, P.A. To see the Department of Justice memo in support of intervention, click here. For more information about qui tam law and Medicare fraud, contact Nolan and Auerbach, PA.

The joint DOJ-HHS Medicare Fraud Strike Force typically operates independently of qui tam investigations and cases. The Strike Force is a multi-agency team of federal, state and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing. More than 360 law enforcement agents from the FBI, HHS-Office of Inspector General (HHS-OIG), multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies participated in the operation.

According to the court documents, the defendants participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and oftentimes, never provided. In many cases, indictments and complaints allege that beneficiaries accepted cash kickbacks in return for allowing providers to submit forms saying they had received the treatments that, in reality, were unnecessary or never provided.

For the full release click here.  For more information about qui tam law and Medicare fraud, contact Nolan and Auerbach, PA.

The GAO strategies should be implemented by the Department of Health and Human Services and its components, the OIG and CMS. The strategies are intended to ward off fraud before it happens, something which will benefit taxpayers in the long run. Medicare and Medicaid has too long been a pay and chase reimbursement system.

For the GAO Report or information about qui tam law and Medicare fraud, contact Nolan and Auerbach, PA.

The hospitals are alleged to have overcharged Medicare between 2000 and 2008 when performing kyphoplasty, a minimally-invasive procedure used to treat certain spinal fractures. The hospitals performed the procedure on an in-patient, rather than less expensive outpatient basis, in order to increase their Medicare billings.

The settling facilities and the amount being paid by each to the United States are Ball Memorial Hospital, Muncie, Ind. ($1,995,431); Bethesda Memorial Hospital, Boynton Beach, Fla. ($356,079); Bloomington Hospital, Bloomington, Ind. ($1,443,848); Genesys Regional Medical Center, Grand Blanc, Mich. ($931,742); Huntsville Hospital, dba The Health Care Authority of the City of Huntsville, Huntsville, Ala. ($1,992,756); Palmetto Health dba Palmetto Health Baptist Hospital, Columbia, S.C. ($1,861,083.14); St. Elizabeth Medical Center, Utica, N.Y. ($195,976); St. Mary’s of Michigan Hospital, Saginaw, Mich. ($260,065.21); and United Hospital, St. Paul, Minn. ($428,656).

The government settled Medicare fraud cases in 2009 with nine other hospitals for kyphoplasty-related claims, as well as settled for $75 million in 2008 with Medtronic Spine LLC, corporate successor to Kyphon Inc., for causing the Kyphoplasty – related claims. Whistleblowers, or qui tam relators, helped to expose the alleged wrongdoing.

For the full release click here.  For more information about qui tam law and Medicare fraud, contact Nolan and Auerbach, PA.

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

For the full press release, go to: http://www.justice.gov/opa/pr/2010/March/10-civ-240.html. For more information about qui tam law and Medicare fraud, contact Nolan and Auerbach, PA.

The two lawsuits were brought under the qui tam, or whistleblower, provisions of the False Claims Act. They alleged that the hospital inflated its charges to obtain supplemental outlier payments for cases that were not extraordinarily costly and for which outlier payments should not have been paid, according to the DOJ.

For the full release click here.  For more information about qui tam law and Medicare fraud, contact Nolan and Auerbach, PA.

He said such payments, which include Medicare fraud and Medicaid fraud, amounted to more than is spent on the Education Department and the Small Business Administration combined, according to the article.

Obama’s anti-fraud approach includes hiring private auditing firms, called Recovery Audit Contractors, or RACs, to comb health care businesses—including doctors’ practices—for health care fraud and abuse. The auditors, like whistleblowers or qui tam relators, would keep part of what they help to recover.

The White House said a Medicare pilot program, using such auditors, recouped $900 million for taxpayers from 2005-08, according to AP. We think the RAC’s provide a huge savings to taxpayers at minimum just because of the deterrent effect alone. It is our understanding that health systems are generally aware of upcoming audits and their scope. The recoveries they have centered on medical necessity of inpatient admissions, an area we believe will be an upcoming focus of the OIG.

Click here here for the full story.  For more information about qui tam law and Medicare  fraud, contact Nolan and Auerbach, PA.

To review the budget outline, go to http://www.whitehouse.gov/omb/budget/. Or, for more information about Medicare fraud, contact Nolan and Auerbach, PA.

The United States alleged that FORBA was liable for causing the submission of claims for reimbursement for a wide range of dental services provided to low-income children that were either medically unnecessary or performed in a manner that failed to meet professionally-recognized standards of care. These services included performing pulpotomies (baby root canals), placing crowns, administering anesthesia (including nitrous oxide), performing extractions, and providing fillings and/or sealants.

For the full release, go to: http://www.justice.gov/opa/pr/2010/January/10-civ-052.html.

For more information about qui tam law and health care fraud, contact Nolan and Auerbach, PA.