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.

Posts tagged as:

Anti Kick Back Laws

Hospitals Accused of $50 Million Medicare Fraud

by Nolan and Auerbach on January 19, 2009

Albany N.Y.—According to The Associated Press, recent lawsuits allege that four New York hospitals (Columbia Memorial Physicians Hospital, Long Beach Medical Center, New York Downtown Hospital, St. Joseph’s Medical Center) paid kickbacks to elicit patients for drug treatment programs and billed Medicaid for unnecessary services that lacked state certification. Separately, the suits accuse four of [...]

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HealthSouth and Its Doctors Pay Nearly $15 Million Settlement to Government

by Nolan and Auerbach on January 2, 2008

HealthSouth is the nation’s largest provider of inpatient rehab services and was formerly one of the largest providers of outpatient rehab services, ambulatory surgery services and diagnostic imaging services until it sold those businesses earlier this year.  However, illegal Kickbacks and False Claims have cost HealthSouth Corporation and two of its physicians nearly $15 million.  [...]

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New York Hospital Appears to be Under Investigation for Possible Health Care Fraud and Kickbacks

by Nolan and Auerbach on March 14, 2007

Westchester Medical Center received a subpoena on January 31, 2007 from Office of Inspector General of the U.S. Department of Health and Human Services, asking for information going back to 1997, primarily related to the hospital’s relationships with its doctors.  Under Stark and  anti-kickback laws, hospitals are not permitted to give physicians inducements for patient [...]

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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 [...]

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