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.

OIG Chief Counsel Gives Senate Testimony on Commercial Sponsorship of Continuing Medical Education

by Nolan and Auerbach on August 31, 2009

On July 29, 2009, Lewis Morris, chief counsel, Office of Inspector General (OIG) testified before the Senate about the risks of commercial sponsorship of continuing medical education (CME) and solutions for ensuring a more bona fide educational purpose.

He cited one study suggesting that “the return on investment for pharmaceutical promotional strategies indicates that spending $1 on physician events and meetings, including CME, generated an average of $3.56 in increased revenue.”

Morris also cited several instances where sponsoring health care education can lead to pharmaceutical fraud, with companies promoting off-label uses of products, such as medications, as well as criminal kickbacks to physicians and others.

“The surest way to eliminate commercial bias in CME is to eliminate industry sponsorship by funders who have a significant financial interest in physicians’ clinical decisions,” according to Morris, who admits that, without being able to rely on industry sponsorship, CME providers would need to identify alternative sources of funds to maintain the availability of CME.

In his testimony, Morris recommends approaches which would allow continued access to industry funding for CME, but limit industry’s ability to influence how that money is used and what messages physicians receive.

For the entire testimony, go to: http://oig.hhs.gov/testimony/docs/2009/07292009_oig_testimony.pdf.

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

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