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.

Grassley Introduces Bill to Fight Medicare Fraud

by Nolan and Auerbach on November 16, 2009

Working to protect taxpayers and Medicare beneficiaries, U.S. Senator Chuck Grassley has introduced legislation to give the federal government more time to pay Medicare providers when waste, fraud and abuse is suspected, according to a November 16, 2009 press release on IowaPolitics.com.

Right now, federal law requires that Medicare send payment within a very short time frame, even when there is risk of fraud, waste or abuse.

The bill Grassley introduced on November 16 – the Fighting Medicare Payment Fraud Act of 2009 – would give the Secretary of Health and Human Services authority to extend the time period in which payments must be made under the prompt payment rule if the Secretary determines there is a likelihood of fraud, waste or abuse. With this additional time, the Secretary would be required to conduct more detailed reviews of the claims in question to make sure they are supposed to be paid.

The Grassley bill also requires the experts in the Office of Inspector General to recommend, on at least an annual basis, categories of providers or suppliers where additional scrutiny is needed before payments are made under the prompt payment rule. To make sure there is action on these recommendations, the Secretary would be required to provide a response to the Inspector General on these recommendations, according to the release.

For the full press release, go to: http://www.iowapolitics.com/index.iml?Article=177068.

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

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