Medicare Fraud 101 » False Claims Act http://medicare-fraud.net Medicare Fraud News, Breaking Headlines and Insight from the Qui Tam Perspective Thu, 10 May 2012 17:55:57 +0000 en hourly 1 http://wordpress.org/?v=3.3.2 Rush University Medical Center to Pay More than $1.5 Million http://medicare-fraud.net/rush-university-medical-center-to-pay-more-than-1-5-million/ http://medicare-fraud.net/rush-university-medical-center-to-pay-more-than-1-5-million/#comments Tue, 30 Mar 2010 15:51:12 +0000 Nolan and Auerbach http://medicare-fraud.net/?p=286 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 office space with two individual physicians and three physician practice groups that violated the Stark Law. Office space leased to a referring physician may be considered proper under the Stark Statute, but only if the rent over the term of the lease is consistent with fair market value and is not determined in a way that takes into account the volume or value of referrals or other business generated between the parties. The “Stark Statute” prohibits a hospital (or other entity providing healthcare items or services) from submitting Medicare claims for payment based on patient referrals from physicians having an improper “financial relationship” (as defined in the statute) with the hospital. Rush is one of several defendants in a suit brought in 2004 by two individuals under the whistleblower provisions of the False Claims Act.

For the full press release, go to: http://www.justice.gov/opa/pr/2010/March/10-civ-240.html. For more information about qui tam law and Medicare fraud, contact Nolan and Auerbach, PA.

]]> http://medicare-fraud.net/rush-university-medical-center-to-pay-more-than-1-5-million/feed/ 0 Robert Wood Johnson University Hospital to Pay $6.35 Million to Resolve Medicare Fraud Allegations http://medicare-fraud.net/robert-wood-johnson-university-hospital-to-pay-6-35-million-to-resolve-medicare-fraud-allegations/ http://medicare-fraud.net/robert-wood-johnson-university-hospital-to-pay-6-35-million-to-resolve-medicare-fraud-allegations/#comments Mon, 22 Mar 2010 15:02:31 +0000 Nolan and Auerbach http://medicare-fraud.net/?p=282 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 obtain larger reimbursements from the federal health care program.

The two lawsuits were brought under the qui tam, or whistleblower, provisions of the False Claims Act. They alleged that the hospital inflated its charges to obtain supplemental outlier payments for cases that were not extraordinarily costly and for which outlier payments should not have been paid, according to the DOJ.

For the full release click here.  For more information about qui tam law and Medicare fraud, contact Nolan and Auerbach, PA.

]]> http://medicare-fraud.net/robert-wood-johnson-university-hospital-to-pay-6-35-million-to-resolve-medicare-fraud-allegations/feed/ 0 National Dental Management Company Pays $24 Million to Resolve False Claims Act Allegations http://medicare-fraud.net/national-dental-management-company-pays-24-million-to-resolve-false-claims-act-allegations/ http://medicare-fraud.net/national-dental-management-company-pays-24-million-to-resolve-false-claims-act-allegations/#comments Mon, 25 Jan 2010 03:44:52 +0000 Nolan and Auerbach http://medicare-fraud.net/?p=268 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 bills to be submitted to state Medicaid programs for medically unnecessary dental services performed on children insured by Medicaid.  FORBA also is cooperating with investigators by providing information about dentists who may have violated professional standards, according to a Jan. 20, 2010 press release by the U.S. Department of Justice.

The United States alleged that FORBA was liable for causing the submission of claims for reimbursement for a wide range of dental services provided to low-income children that were either medically unnecessary or performed in a manner that failed to meet professionally-recognized standards of care. These services included performing pulpotomies (baby root canals), placing crowns, administering anesthesia (including nitrous oxide), performing extractions, and providing fillings and/or sealants.

For the full release, go to: http://www.justice.gov/opa/pr/2010/January/10-civ-052.html.

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

]]> http://medicare-fraud.net/national-dental-management-company-pays-24-million-to-resolve-false-claims-act-allegations/feed/ 0 Texas Hospital to Pay U.S. Nearly $1 Million for Allegations it Violated the False Claims Act http://medicare-fraud.net/texas-hospital-to-pay-us-nearly-1-million-for-allegations-it-violated-the-false-claims-act/ http://medicare-fraud.net/texas-hospital-to-pay-us-nearly-1-million-for-allegations-it-violated-the-false-claims-act/#comments Fri, 08 Jan 2010 01:28:31 +0000 Nolan and Auerbach http://medicare-fraud.net/?p=264 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 claims for payment to the Medicare program between July 1, 2003, and July 1, 2007, for pulmonology-related items and services.

In August 2007, Arlington Memorial’s corporate parent self-disclosed to the Office of Inspector General for the Department of Health and Human Services (OIG) that a long-standing contract with a physician group for the interpretation of arterial blood gas (ABG) tests potentially violated federal law. The U.S. contends that Arlington Memorial Hospital knowingly failed, through the actions of its former president, to eliminate payments to the group for the interpretations of hospital tests that were not performed, and that Arlington Memorial Hospital AMH knew such payments were not in compliance with federal legal requirements, according to the U.S. Department of Justice press release.

For the full release, go to: http://www.justice.gov/usao/txn/PressRel10/arlington_memorial_hospital_settle_pr.html.

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

]]> http://medicare-fraud.net/texas-hospital-to-pay-us-nearly-1-million-for-allegations-it-violated-the-false-claims-act/feed/ 0 Teaching Hospital Settles Physician Billing Case http://medicare-fraud.net/teaching-hospital-settles-physician-billing-case/ http://medicare-fraud.net/teaching-hospital-settles-physician-billing-case/#comments Thu, 16 Jul 2009 19:11:03 +0000 Nolan and Auerbach http://medicare-fraud.net/?p=222 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 on behalf of physicians who were not present when residents performed the procedures.

 

LSUHSC-S agreed to pay more than $700,000 to resolve the False Claims Act allegations. The complaint was initiated by two employees-turned-whistleblowers who both plan to file another suit to collect lost wages, benefits, and damages for their damaged reputations.

 

Ken was quoted on the connection between this settlement and Physicians at Teaching Hospitals (PATH), the Department of Justice (DOJ) and Office of Inspector General’s (OIG) national enforcement project in the area of teaching physicians. While the goal of PATH was to target major offenders, Ken does not find it surprising that smaller offenders like LSUHSC-S are showing up with independent whistleblower cases. This is one of the several beneficial scenarios to taxpayers that the qui tam law was intended to capture. Ken also highlighted that many settlements are now originated with whistleblowers, instead of the DOJ or OIG like with PATH.

]]> http://medicare-fraud.net/teaching-hospital-settles-physician-billing-case/feed/ 1 Physicians Snared By Growing Medicare Fraud Strike Team http://medicare-fraud.net/physicians-snared-by-growing-medicare-fraud-strike-team/ http://medicare-fraud.net/physicians-snared-by-growing-medicare-fraud-strike-team/#comments Wed, 15 Jul 2009 19:02:27 +0000 admin http://medicare-fraud.net/?p=218 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 healthcare professionals for allegedly scheming to submit false Medicare claims in the Detroit area.

These indictments come immediately after the government recently publicized the creation of a Medicare anti-fraud task force aimed at reducing the millions of dollars wasted every year in healthcare fraud. The task force has said it will focus on all participants in fraud, be it the corporation, the physician, or even patients.  

Marcella pointed out that she believed there will be many more similar Medicare fraud indictments and cases in the near future. Meanwhile, whistleblowers will continue to play an important and crucial role in the government’s crackdown on healthcare fraud. When employees or physicians who are aware of misconduct do not come forward, the government will initiate investigations proactively, often resulting in a large number of indictments against the company or hospital, as demonstrated by this bellwether case in Detroit.

]]> http://medicare-fraud.net/physicians-snared-by-growing-medicare-fraud-strike-team/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 Texas-Based Nursing and Rehabilitation Centers to Pay U.S. $4 Million for Alleged False Medicare and Medicaid Billings http://medicare-fraud.net/alleged-false-medicare-and-medicaid-billings/ http://medicare-fraud.net/alleged-false-medicare-and-medicaid-billings/#comments Thu, 21 May 2009 19:11:01 +0000 Nolan and Auerbach http://medicare-fraud.net/?p=192 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 and operates 24 nursing home facilities located through the state, according to the release.

The False Claims Act settlement resolves allegations that Regency submitted claims for reimbursement to Medicare and Medicaid for rehabilitation and skilled nursing services that were not reimbursable because the nursing home residents were not qualified for the services, the services were not medically necessary, or they were not supported by adequate documentation, according to the release.

For the full press release, go to: US DOJ.

For more information about Qui Tam law and Health Care Fraud, contact Nolan and Auerbach, PA.

]]> http://medicare-fraud.net/alleged-false-medicare-and-medicaid-billings/feed/ 0 Calif. County to Pay U.S. $6.8 Million for Allegations of False Medicare, Medicaid Claims http://medicare-fraud.net/calif-county-to-pay-us-68-million-for-allegations-of-false-medicare-medicaid-claims/ http://medicare-fraud.net/calif-county-to-pay-us-68-million-for-allegations-of-false-medicare-medicaid-claims/#comments Wed, 18 Mar 2009 14:02:37 +0000 Nolan and Auerbach http://medicare-fraud.net/?p=166 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 Medicare Fraud by falsely inflated its bed count to Medicare in order to receive higher payments under Medicare’s Disproportionate Share Hospital (DSH) adjustment. The government also alleges that San Mateo County improperly obtained federal payments under the Medicaid program for services provided to patients at Institutes of Mental Disease (IMDs) who were between the ages of 22 and 64. This is once again an example of a case where the simple manipulation of a few numerals results in overpayments of millions of dollars. The lawsuit was filed under the qui tam or whistleblower provisions of the False Claims Act by a former employee of San Mateo County.

For a copy of the full press release, http://www.usdoj.gov/opa/pr/2009/March/09-civ-224.html. For more information about qui tam whistleblower law, contact Nolan and Auerbach, PA.

]]> http://medicare-fraud.net/calif-county-to-pay-us-68-million-for-allegations-of-false-medicare-medicaid-claims/feed/ 0 Two Chicago Cardiologists Charged With Medicare Fraud http://medicare-fraud.net/two-chicago-cardiologists-charged-with-medicare-fraud/ http://medicare-fraud.net/two-chicago-cardiologists-charged-with-medicare-fraud/#comments Tue, 10 Feb 2009 18:02:15 +0000 Nolan and Auerbach http://medicare-fraud.net/?p=19 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 $8.3 million to Medicare and $5.1 million to other insurers.

In the second case,  general practitioner Otto Garcia Montenegro was charged with healthcare fraud—for using his Chicago-area clinic to submit false claims over a period of four years (2003-2007). Rather than collecting co-pays and deductibles from his patients in accordance with the standard procedure, Montenegro submitted hundreds of claims to insurers for treatments that were never performed.  As a result, he collected nearly $900,000 in payment from health care insurers and exhausted patient deductibles in the process.

Regarding their cases, United States Attorney Patrick Fitzgerald said: “Healthcare fraud remains an important priority of federal law enforcement. We will use all of our resources to ensure that dishonest physicians and other medical providers do not profit from cheating Medicare and private insurers.”

While this announcement involved criminal indictments, it is likely that prosecutions under the federal False Claims Act will follow.

To read the full press release, go here.

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