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.

Inspector general addresses health care fraud

by Nolan and Auerbach on June 26, 2009

On Thursday, June 25, 2009, Daniel R. Levinson presented testimony on the Office of the Inspector General’s (OIG’s) role in addressing health care waste, fraud and abuse, as well as its plans for health care reform.

Talking before the Subcommittee on Health of the House Energy and Commerce Committee Levinson, inspector general of the U.S. Department of Health and Human Services (HHS), said these recommendations were based on OIG’s evaluations, investigations and audits on issues, such as fraudulent activity by health care providers; excessive payments for medical services, equipment, and prescription drugs; and financial conflicts of interests within the institutions charged with protecting the health of the American public.

He emphasized that collaboration and innovation are essential in the fight against fraud. Levinson cited the launch of Health Care Fraud Prevention and Enforcement Action Team (HEAT), a joint task force consisting of OIG and Department of Justice senior leadership.

The inspector general identified health care vulnerabilities to fraud and waste and outlined OIG’s program to strengthen the integrity of government-run health care, called the Five-Principle Strategy to Combat Health Care Fraud, Waste, and Abuse.

For the full testimony, go to: http://www.oig.hhs.gov/testimony/docs/2009/06252009_testimony_health_reform.pdf.

For more information about qui tam law and health care fraud, contact Nolan and Auerbach, PA. http://www.whistleblowerfirm.com/.

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