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.

Medicare Scam Results in Indictment of California Doctor and Employee

by Nolan and Auerbach on September 24, 2007

Dr. Kenneth Ferguson, a physician of record at Huntington Beach Medical Center which operated from July through October 2004 was indicted by a federal grand jury in Santa Ana, California along with his employee Olena Kulakova for health care fraud. According to the allegations, Dr. Ferguson and his employee Kulakova would bill Medicare for physician services for care rendered to patients by Kulakova. Kulakova had no medical license in the State of California even though she held herself out to be either a doctor or a physician’s assistant. Both Dr. Ferguson and Kulakova caused Medicare to be billed for comprehensive evaluation and management visits for patients even though face time with patients lasted only 5 to 10 minutes as opposed to the usual 25 to 45 face to face time with a patient. In addition, it is alleged that both Dr. Ferguson and Kulakova directed and caused kickbacks to be paid to patients to come to the Huntington Beach Medical Center for Services.

Both defendants face a maximum of 100 years in federal prison and fines in excess of $2,000,000 if convicted.

To read more about this case click here; or read more about medicare fraud and qui tam actions.

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