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.

President Obama Vows to Eliminate Healthcare Fraud and Reduce Waste

by Nolan and Auerbach on September 10, 2009

On Wednesday, September 9, 2009, President Barack Obama addressed Congress on the current debate over healthcare reform. In his speech, the President vowed he would eliminate “the hundreds of billions of dollars in waste and fraud.” Under his plan, an independent commission of doctors and medical experts would be appointed the task of uncovering fraud and abuse in the coming years.

President Obama’s speech further confirms that the fight against healthcare fraud is a top priority for the government, and its recently heightened efforts to recoup healthcare dollars by prosecuting violators underscores that message. Simply put, in order to afford a viable healthcare system unnecessary spending must be eliminated. We’ve said it before – the government is keeping a watchful eye on Medicare and Medicaid fraud, as well as fraud within the pharmaceutical industry. In fact, just last week the Office of Inspector General announced Medicaid Fraud Control Units recovered $1.3 billion in 2008.

Needing all the help they can get, federal regulators see whistleblowers as crucial players in the fight against healthcare fraud. As Marcella Auerbach pointed out in an interview with PBS in July, the healthcare industry receives a $15 return for every dollar the government spends on efforts to fight fraud. By spotting fraud early on, significant money can be recovered for patients and taxpayers.

For the entire transcript of President Obama’s speech, go to:
http://www.whitehouse.gov/the_press_office/Remarks-by-the-President-to-a-Joint-Session-of-Congress-on-Health-Care/

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

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