Medicare Fraud

Every year, we lose billions of dollars to fraud in federal and state health care programs. Every dollar we lose to fraud and abuse is a dollar that is not available to provide home care to seniors, to treat HIV and AIDS, to immunize children, and to discover new treatments for cancer and other diseases. Some fraud schemes even pose a direct threat to the health and safety of patients. Many instances of health care fraud sug­gest that existing control systems do not work the way we imagine they should. Often the manner in which schemes are revealed suggests detection is more luck than system. Whistleblower lawsuits have exposed billing by health care providers for services not rendered, billing for products not delivered, misrepresenting services, unbundling services, billing for medically unnecessary services, duplicate billing, increasing units of service which are subject to a payment rate, falsifying cost reports resulting in increased payment to the health care provider, kickbacks, and on and on. Healthcare fraud is still going strong and this blog is intended to keep readers up to date with all healthcare fraud related news and to provide commentary when warranted. This blog also contains an array of laws and regulations concerning healthcare fraud set out in an easy to read format.

Government Health Care Programs Improperly Paid Out $70 Billion in 2010

by Nolan and Auerbach on September 23, 2011

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 accounts for a whopping 64% of the improper government payments in 2010. By focusing efforts on this sizeable $70.4 billion improper price tag, the government would see its largest return per investigative dollar.

This week, the government took steps to turn off the spigot of improper government health care dollars. Specifically, the U.S. Department of Health and Human Services rolled out its final regulations for a new Medicaid Recovery Audit Contractor (RAC) Program, mandated by the Obama Health Reform legislation of 2010. Modeled after the Medicare RAC program, this new initiative pays contractors 9 percent to 12.5 percent of any improper Medicaid payments they recover.

Undoubtedly, the Medicaid RAC program will up the number of auditors watching the stream of government spending. However, to efficiently and effectively fish out improper payments, the government still needs the inside knowledge and expertise of courageous whistleblowers. Indeed, without the help of whistleblowers to spot these seemingly innocuous claims, improper payments will easily flow by auditors.

Moreover, with a growing river of health care spending and its attendant Medicare fraud, there can be no shortage of individuals willing to suit up under the qui tam provisions of the False Claims Act. For those who successfully recover government funds via a qui tam action, their courageous actions could be worth up to 30% of the funds recovered by the government.

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

 

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