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.

Hospitals Accused of $50 Million Medicare Fraud

by Nolan and Auerbach on January 19, 2009

Albany N.Y.—According to The Associated Press, recent lawsuits allege that four New York hospitals (Columbia Memorial Physicians Hospital, Long Beach Medical Center, New York Downtown Hospital, St. Joseph’s Medical Center) paid kickbacks to elicit patients for drug treatment programs and billed Medicaid for unnecessary services that lacked state certification. Separately, the suits accuse four of the hospitals of engaging in a kickback scheme to illegally refer patients to the hospitals’ detox units. In a related series of events, Queens’ Parkway Hospital, Our Lady of Mercy, and Benedictine Hospital were accused of paying people to solicit homeless individuals for a three-day detox unit in exchange for cigarettes, beer, food, and other items.  Several of the alleged hospitals were aided by SpecialCare Hospital Management Corp., who illegally referred patients for a fee.

Collectively, the aforementioned hospitals fraudulently billed Medicaid for more than $50 million over a total of 14,000 different claims.  Attorney General Andrew Cuomo asserts that these hospitals have violated New York’s anti-kickback laws, which prohibit individuals or entities from knowingly and willfully offering, paying, soliciting or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid or any other federally funded program (except the Federal Employees Health Benefits Program).. As of now, the state has settled for $4.5 million with Our Lady of Mercy, which denies any wrongdoing.  Likewise, the other hospitals and their management companies have denied all charges and filed motions to have the cases dismissed.
To learn more go here or if you have a Medicare Fraud or False Claims Act case contact Nolan & Auerbach P.A.

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