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 York Hospital Agrees to Settle Qui Tam

by Nolan and Auerbach on March 6, 2009

The Government announced today that a former employee  of Victory Memorial Hospital’s qui tam lawsuit has resulted in a settlement with the United States of at least $2.3 million to resolve claims that the hospital defrauded the Medicare program.

The Medicare Fraud settlement covers allegations that Victory Memorial submitted Cost Reports for 1996 and 1997 that understated certain revenues for patient care, known as “charges.” This allegedly resulted in Victory Memorial having a higher Cost to Charge Ratio for those years, which in turn resulted in Victory Memorial obtaining higher reimbursements for Medicare for certain services. The employee was represented by Nolan and Auerbach P.A. as co-counsel with the law offices of Timothy McInnis.

To see the Government press release, click here.

Leave a Comment