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.

New Report Suggests Waste, Including Health Care Fraud, Is One Third the Health Care Budget

by Nolan and Auerbach on October 30, 2009

Keith Olbermann reported on MSNBC’s Countdown October 27 that President Obama has said that eliminating waste could pay for most of any health care reform package. But critics disagree. Those critics might be more than a little wrong. Olbermann says a new study suggests the President might have underestimated just how much waste there is. The U.S. Health care system wastes $505 billion, perhaps $850 billion, every year. This is according to an independent study by Thomson Reuters.

The report, released October 26, 2009 by Thomson Reuters, attributes most of the waste to unnecessary care, such as the overuse of medications and diagnostic tests. The next largest category of waste is health care fraud, which according to the report, costs $125 billion to $175 billion each year and includes everything from fraudulent Medicare claims to kickbacks for referrals for unnecessary services.

The bad news is that one-third of our health care budget in America is spent on waste. The good news is that this is something we can change and that reporting health care fraud is a significant step in that direction.

For the full Thomson Reuters release, go to: http://thomsonreuters.com/content/press_room/tsh/waste_US_healthcare_system.

For more information about qui tam law and health care fraud, contact Nolan and Auerbach, PA. 

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