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.

HealthSouth and Its Doctors Pay Nearly $15 Million Settlement to Government

by Nolan and Auerbach on January 2, 2008

HealthSouth is the nation’s largest provider of inpatient rehab services and was formerly one of the largest providers of outpatient rehab services, ambulatory surgery services and diagnostic imaging services until it sold those businesses earlier this year.  However, illegal Kickbacks and False Claims have cost HealthSouth Corporation and two of its physicians nearly $15 million.  This is what is took to settle allegations that false claims were submitted to the government and illegal kickbacks were paid to orthopedic surgeons who referred patients for care to HealthSouth Corp. hospitals, outpatient rehab clinics and ambulatory surgery centers.  The Department of Justice is continuing to investigate other improper physician referral relationships.

The Anti-Kickback Statute arose out of congressional concern that payoffs to those who can influence healthcare decisions will result in goods and services being provided that are medically unnecessary, of poor quality or even harmful to a vulnerable patient population.  To deter these harms, Congress enacted a per se prohibition against the payment of kickbacks in any form, regardless of whether the particular kickback gave rise to over utilization or poor quality of care.

To read the full story click here or click the following for more about the False Claims Act and Anti-kickback Laws.

If you believe you have information concerning a violation of the False Claims Act and want to read more about Nolan & Auerbach, P.A. you may contact us.

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