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.

Oops! CMS Paid Millions to Medicare Advantage Plans after Enrollees Died

by Nolan and Auerbach on March 11, 2009

The Centers for Medicare and Medicaid Services (CMS) paid about $4.4 million to Medicare Advantage plans on behalf of enrollees, after those enrollees had died. CMS made the improper payments for 2,657 deceased enrollees between January 2003 and April 2007, according to the March 2009 report “Review of Medicare Payments to Managed Care Plans on Behalf of Deceased Enrollees.”

In the report, Department of Health and Human Services Inspector General Daniel R. Levinson said that his department had recommended that CMS not only recoup the $4.4 million but also correct these improper payments in the future. CMS replied that it had only been able to recover $3.5 million of the unallowable payments due, primarily, to limited resources. CMS and the Office of Inspector General (OIG) have since worked together on procedures to prevent Medicare payments to the deceased, but OIG continues to recommend that CMS recoup the rest of the $4.4 million.

For the entire report, go to http://www.oig.hhs.gov/oas/reports/region7/70701046.pdf. Or, for more information about Medicare fraud, contact Nolan and Auerbach, PA.

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