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 INTERVENES IN SUIT AGAINST ST. JUDE MEDICAL ALLEGING KICKBACKS

by Nolan and Auerbach on August 9, 2010

The United States Department of Justice announced that it was seeking to intervene in a whistleblower suit alleging that St. Jude Medical, Inc. violated the False Claims Act.

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.

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