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.

HHS-OIG Audit: Health Care Providers Improperly Billed Medicare 75% of the Time

by Nolan and Auerbach on December 5, 2011

Whether through omission or commission, health care providers regularly overbill Government Health Care Programs. This message has been echoed, time and time again, in audit reports from the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG).

In the most recent audit report, HHS-OIG found that the audited providers overbilled Medicare 75% of the time. In a sample size of 1,290 line item payments involving Medicare outpatient services from January 2006 through June 2009, providers improperly billed Medicare 969 times, for more expensive treatments and for unallowable services.

Interestingly, the Medicare contractor that processed these claims did not flag a single improper payment. In other words, all 969 improper claims sailed through the payment system without a single denial or demand for refund. Indeed, these wrongful claims only came to light during the HHS-OIG claim-by-claim audit. The Medicare System needs courageous whistleblowers to step forward and fill this protective void by identifying Medicare fraud. Otherwise, our Government Health Care Programs are in jeopardy.

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

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