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 Claims Act

Rush University Medical Center to Pay More than $1.5 Million

by Nolan and Auerbach on March 30, 2010

Rush University Medical Center has agreed to pay $1,547,200 plus interest to resolve allegations that the facility violated the False Claims Act, the U.S. Department of Justice (DOJ) announced March 9, 2010. Rush is alleged to have submitted false claims to Medicare during the period 2000 through 2007 by entering into certain leasing arrangements for [...]

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Robert Wood Johnson University Hospital to Pay $6.35 Million to Resolve Medicare Fraud Allegations

by Nolan and Auerbach on March 22, 2010

Robert Wood Johnson University Hospital Hamilton, a New Jersey-based hospital, has agreed to pay $6.35 million to settle allegations that the hospital defrauded Medicare, the United States Department of Justice (DOJ) announced March 19, 2010. Two lawsuits filed against the Hamilton, N.J., facility alleged that the hospital fraudulently inflated its charges to Medicare patients to [...]

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National Dental Management Company Pays $24 Million to Resolve False Claims Act Allegations

by Nolan and Auerbach on January 24, 2010

The United States has settled False Claims Act allegations against FORBA Holdings LLC, a dental management company that provides business management and administrative services to 69 clinics nationwide known as “Small Smiles Centers.” Under the agreement, FORBA will pay the United States and participating states $24 million, plus interest, to resolve allegations that it caused [...]

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Texas Hospital to Pay U.S. Nearly $1 Million for Allegations it Violated the False Claims Act

by Nolan and Auerbach on January 7, 2010

Arlington Memorial Hospital, Arlington, Texas, has agreed to pay the U.S. $990,509.50 to resolve allegations that it violated the civil False Claims Act, according to a Jan. 4, 2010 announcement by U.S. Attorney James T. Jacks of the Northern District of Texas. The Texas hospital allegedly violated the civil False Claims Act by submitting improper [...]

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Teaching Hospital Settles Physician Billing Case

by Nolan and Auerbach on July 16, 2009

In the July 13 edition of the Report on Medicare Compliance, Editor Nina Armstrong quoted Ken Nolan in her article titled, “Teaching Hospital Settles Physician Billing Case, Signs Second Agreement with OIG.” The article reported that Louisiana State University Health Sciences Center in Shreveport (LSUHSC-S) recently settled a dispute alleging it billed Medicare for surgery [...]

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Physicians Snared By Growing Medicare Fraud Strike Team

by admin on July 15, 2009

Marcella Auerbach was quoted by Amy Lynn Sorrel in her article “Physicians snared by growing Medicare fraud strike team,” which appeared in the July 6 online edition of American Medical News. The article discussed the announcement by the Department of Justice and Health & Human Services that criminal charges were filed against 53 doctors and [...]

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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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Texas-Based Nursing and Rehabilitation Centers to Pay U.S. $4 Million for Alleged False Medicare and Medicaid Billings

by Nolan and Auerbach on May 21, 2009

Regency Nursing and Rehabilitation Centers Inc. nursing home chain will pay the United States $4 million to settle allegations that Regency submitted false claims to Medicare and the Texas Medicaid program, the Justice Department and the U.S. Attorney’s Office for the Southern District of Texas announced May 21, 2009. The Victoria, Texas-based chain currently owns [...]

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Calif. County to Pay U.S. $6.8 Million for Allegations of False Medicare, Medicaid Claims

by Nolan and Auerbach on March 18, 2009

The U.S. Department of Justice announced March 12, 2009, that San Mateo County, Calif., will pay the United States $6.8 million to resolve allegations that the San Mateo Medical Center (SMMC) submitted false claims to the United States in connection with payments from the Medicare and Medicaid programs. The government alleges that SMMC engaged in [...]

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Two Chicago Cardiologists Charged With Medicare Fraud

by Nolan and Auerbach on February 10, 2009

Chicago, Illinois—  Cardiologist Sughil Sheth received $13.4 million over a period of five years (2002-2007) by billing Medicare for reimbursement of extensive cardiac care that was not, according to U.S. Attorney Patrick Fitzgerald, ever performed.  Sheth allegedly performed Medicare Fraud by hiring individuals to falsify patient names, insurance data, and dates in order to bill [...]

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