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.

Homecare Association Presents 13-point Plan to Eliminate Medicare Waste, Fraud and Abuse

by Nolan and Auerbach on May 7, 2009

In April 2009, the American Association for Homecare presented Congress with its 13-point legislative action plan, called the Medicare Anti-Fraud Legislative Plan, aimed at eliminating waste, fraud and abuse in Medicare’s home medical equipment sector.

The plan’s steps, according to the homecare association, would eliminate most of the Medicare fraud attributed to the home medical equipment sector by attacking the problem at the front of the process rather than relying on the “pay-and-chase” approach to stop fraud.  Included in the recommendations: mandate site inspections for all new home medical equipment providers and require site inspections for all home medical equipment provider renewals.

We applaud this Association for its efforts. Its members and taxpayers would be well served if some of the Plan is adopted by congress.

For more information on the American Association for Homecare’s plan, go to www.aahomecare.org/stopfraud. For a press release on the topic, go to http://news.prnewswire.com/DisplayReleaseContent.aspx?ACCT=104&STORY=/www/story/04-22-2009/0005011280&EDATE. And for more information about qui tam law and health care fraud, contact Nolan and Auerbach, PA.

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