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.

Supreme Court Refuses to Undo Seminal Anti-kickback Decision

by Nolan and Auerbach on January 4, 2012

Recently, the U.S. Supreme Court declined to review a federal appeals court ruling in a closely watched case over whether a defendant can be held liable under the False Claims Act for "causing" health care providers to submit Anti-kickback Statute-violative Medicare claims (Blackstone Medical Inc. v. United States ex rel. Hutcheson, U.S., No. 11-269, review denied 12/5/11). The Supreme Court’s decision not to hear the case lets stand a ruling by the U.S. Court of Appeals for the First Circuit in United States ex rel. Hutcheson v. Blackstone Medical Inc. (1st Cir., 647 F.3d 377 (2011), which correctly held that entities that pay kickbacks are liable under the False Claims Act for the resulting false claims. Certainly, this sends another powerful message to wayward drug and medical device companies that they cannot bribe their way into the medicine cabinets of Medicare beneficiaries. For more information about qui tam law and Medicare fraud, contact Nolan and Auerbach, P.A.

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