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.

Stark Violations Land Hospital in Hot Water

by Nolan and Auerbach on May 10, 2006

A May 9, 2006, Los Angeles Times article (Lisa Girion, U.S. Programs May Exclude Tenet Hospital, The Los Angeles Times, May 9, 2006 at C9), it was reported that, “… the Department of Health and Human Services’ Office of Inspector General notified Dallas-based Tenet that it intended to exclude Alvarado Hospital Medical Center in San Diego from the Medicare program, the Medicaid plan for the poor and all other federal health programs. The decision is based on allegations that Alvarado paid kickbacks over 10 years in order to induce doctors to refer patients for services and items paid for by the federal programs. ” This action follows two mistrials in which jurors were unable to agree as to whether Tenet, Alvarado Hospital Medical Center and a former employee were guilty of related criminal charges.

To read more, see The LA Times.

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