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.

Medical Biller Nabbed in Medicare Fraud Scheme

by Nolan and Auerbach on March 20, 2007

An owner of All Medical Billing Solutions, Inc (All Medical Billing) located in Miami, Florida, was sentenced to 10 years imprisonment after being convicted of conspiracy to defraud Medicare, pay health care kickbacks and laundering health care fraud proceeds.  Sotto’s company submitted fraudulent Project New Hope (a Miami HIV medical clinic) claims to Medicare in excess of $2.8 million and Sotto received more than $600,000 in fraud proceeds.  Five co-defendants previously plead guilty before trial and received sentences from probation to over seven years incarceration.

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