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:

false billings

Double-billing Settlement Highlights Whistleblower Concerns

by Nolan and Auerbach on June 23, 2009

Earlier this week, the University of Medicine and Dentistry of New Jersey agreed to pay the federal government $2 million to settle a whistleblower lawsuit alleging that it bilked Medicaid in a double-billing scheme that started in 1993 and ended in 2003, according to the Department of Justice. The settlement was the second time UMDNJ [...]

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UMDNJ to Pay U.S. $2 Million for Allegations of Medicare Fraud

by Nolan and Auerbach on June 9, 2009

The University of Medicine and Dentistry of New Jersey (UMDNJ) has agreed to pay the United States $2 million to resolve federal civil fraud allegations that its hospital defrauded Medicaid, the Justice Department announced June 9, 2009, according to a press release on PR Newswire. From 1993 to 2004, UMDNJ’s University Hospital submitted claims to [...]

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Medical Supply Company Owner Sentenced for Medicare Fraud

by Nolan and Auerbach on November 30, 2006

A scheme to defraud Medicare resulted in a three year prison term for the owner of medical supply companies in Kansas City and Raytown, Missouri, who sent claims to Medicare totaling more than $5 million dollars for power wheelchairs but substituted a less expensive motortized scooter to nearly 1,000 beneficiaries. His co-defendants, which included two [...]

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The Beat Goes On…Fraud Continues at the University of Medicine and Dentistry of New Jersey

by Nolan and Auerbach on November 21, 2006

A federal monitor’s report found that the University of Medicine and Dentistry of New Jersey made since 2002, $5.7 million in illegal payments to physicians in exchange for their heart patient referrals. As the result of these patient referrals, physicians were given “no-show” teaching jobs in excess of $150,000 per year. The monitoring system was [...]

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