Medicare Fraud 101 » false billings http://medicare-fraud.net Medicare Fraud News, Breaking Headlines and Insight from the Qui Tam Perspective Fri, 03 Feb 2012 22:32:12 +0000 en hourly 1 http://wordpress.org/?v=3.2 Double-billing Settlement Highlights Whistleblower Concerns http://medicare-fraud.net/double-billing-settlement-highlights-whistleblower-concerns/ http://medicare-fraud.net/double-billing-settlement-highlights-whistleblower-concerns/#comments Tue, 23 Jun 2009 14:33:59 +0000 Nolan and Auerbach http://medicare-fraud.net/?p=206 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 paid the government for the double-billing scheme. The first was in 2005 when the hospital paid $4.9 million to the state of New Jersey to settle criminal charges.

In the end, UMDNJ ended up paying nearly $7 million total for the scheme, but, according to Marcella Auerbach, managing partner at Nolan & Auerbach, the hospital could have avoided the lengthy and costly litigation and saved millions, if it had acted differently.

According to Auerbach, a former federal prosecutor who now exclusively represents whistleblowers in healthcare fraud cases, UMDNJ’s in-house attorney discovered the hospital and its physicians were billing for the same services back in 2001-before any whistle was blown. The lawyer brought the issue to the hospital’s attention, but the management looked the other way, and continued to double-bill for the three years following the warning, he says.

The fact that UMDNJ knew about the double-billing, knew it was illegal, and continued to do it, is what makes the case so interesting. According to Auerbach, the hospital could have saved millions if it ceased double-billing and came clean to the government through a self-disclosure.

“It’s a bet,” Auerbach says. “They are betting on the fact they won’t get caught.”

However, UMDNJ hit one too many times and ended up going bust. The man who busted the hospital is Steven Simring, MD, who will collect $801,000 for his efforts.

Based on the details of the case, Auerbach was not surprised to see a doctor blow the whistle on the hospital. Evidence shows that there were many discussions about the double-billing in which doctors expressed concern. Auerbach says it comes as no surprise that Simring would come forward and blow the whistle rather than risk being prosecuted himself.

Auerbach, who has extensive experience in whistleblower cases, says the gambler’s mind-set is common in whistleblower cases. Rather than play by the rules and fess up, many facilities try to sweep problems under the rug and pretend they never happened. Some even go one step further. Auerbach says many times concerned employees will raise a compliance concern only to be handed a pink slip for their trouble, which raises another legal problem.

“These people are fired for bringing points up,” Auerbach says, “Then they come to us and they have two claims.”

Auerbach says this case can be seen as a message to healthcare leaders. The DOJ is saying take any compliance concerns presented by employees or legal council very seriously and, when appropriate, self-disclose. The alternative is a lengthy, expensive, public whistleblower case.

For the entire article, go to: http://www.healthleadersmedia.com/content/234437/topic/WS_HLM2_FIN/Doublebilling-Settlement-Highlights-Whistleblower-Concerns.html

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

]]> http://medicare-fraud.net/double-billing-settlement-highlights-whistleblower-concerns/feed/ 0 UMDNJ to Pay U.S. $2 Million for Allegations of Medicare Fraud http://medicare-fraud.net/umdnj-to-pay-us-2-million-for-allegations-of-medicare-fraud/ http://medicare-fraud.net/umdnj-to-pay-us-2-million-for-allegations-of-medicare-fraud/#comments Wed, 10 Jun 2009 01:37:21 +0000 Nolan and Auerbach http://medicare-fraud.net/?p=203 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 Medicaid for outpatient physician services that were also being billed by doctors working in the hospital’s outpatient centers. By submitting duplicate claims for payment, University Hospital doubled billed the government’s Medicaid program, according to the release.

The case against UMDNJ and University Hospital originated in a qui tam, or whistleblower, complaint filed under the Federal False Claims Act.

For the entire press release, go to: http://news.prnewswire.com/DisplayReleaseContent.aspx?ACCT=104&STORY=/www/story/06-09-2009/0005041208&EDATE.

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

]]> http://medicare-fraud.net/umdnj-to-pay-us-2-million-for-allegations-of-medicare-fraud/feed/ 0 Medical Supply Company Owner Sentenced for Medicare Fraud http://medicare-fraud.net/medical-supply-company-owner-sentenced-for-medicare-fraud/ http://medicare-fraud.net/medical-supply-company-owner-sentenced-for-medicare-fraud/#comments Thu, 30 Nov 2006 15:52:18 +0000 Nolan and Auerbach http://medicare-fraud.net/?p=137 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 former physicians, will be sentenced; each facing as much as 10 years in prison and additional fines and restitution.

To read more on this article click here.

]]> http://medicare-fraud.net/medical-supply-company-owner-sentenced-for-medicare-fraud/feed/ 0 The Beat Goes On…Fraud Continues at the University of Medicine and Dentistry of New Jersey http://medicare-fraud.net/the-beat-goes-on%e2%80%a6fraud-continues-at-the-university-of-medicine-and-dentistry-of-new-jersey/ http://medicare-fraud.net/the-beat-goes-on%e2%80%a6fraud-continues-at-the-university-of-medicine-and-dentistry-of-new-jersey/#comments Tue, 21 Nov 2006 16:00:16 +0000 Nolan and Auerbach http://medicare-fraud.net/?p=144 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 put in place as the result of oversight put in place by the University to avoid prosecution on multi-million dollar fraud charges. This fraudulent scheme could cost the University as much as $84.5 million for these illegal referrals.

The fraudulent activity continues in spite of a $2.2 million settlement paid to a whistleblower in December 2005, who claimed he was fired for objecting to this scheme. The University signed a settlement agreement with the after it was charged with Medicaid fraud involving the double-billing of nearly $5 million worth of procedures.

To read more click here.

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