Medicare Fraud News, Breaking Headlines and Insight from the Qui Tam Perspective
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Cooper University Hospital in New Jersey has agreed to pay $3.8 million to the federal government as the result of inflating its Medicare claims from 2001 to 2003. Specifically the Department of Justice alleged that the hospital improperly increased its charges for inpatient and outpatient care to make it appear that the charges were greater [...]
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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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A corporate insider is in a unique position to know the details about how their employer has cheated the United States Government. Nothing beats the knowledge an insider can impart. Whistleblowers are the real heroes in the fight against fraud. The person (plaintiff) who brings an action under the False Claims Act is called a [...]
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Pediatrix Medical Group, Inc., a network of physician groups who provide medical services in hospital neonatal intensive care units in 32 states has agreed to pay the government over $25 million to settle government claims under the False Claims Act that Pediatrix improperly billed and upcoded reimbursement claims for more expensive treatment than actually provided. [...]
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Employee Section 6032 “Employee Education About False Claims Recovery” requires that entities receiving or making more than $5 million in annual payments under a state Medicaid plan, must, as a condition of participation, create written compliance policies designed to educate employees, contractors and agents about false claims, false statements and whistleblower protections under applicable federal [...]
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As a result of violating Stark Laws and submitting improper bills to Medicare, Medicaid and TRICARE, the Marion County Medical Center in South Carolina will pay $3.75 Million arising out of a qui tam False Claims Act case filed by a whistleblower. For more information click here.
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This case settlement is a recent example of false claims act liability based upon false certification. Although this is not a healthcare fraud case, we point out that false certification in the healthcare fraud field is still probably going strong and the basis for liability. To see a brief story, click here.
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A new Taxpayers Against Fraud Report confirms the success of the Qui Tam provisions of the False Claims Act in fighting health care fraud. To see the full Report, click here.
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The OIG recently released an Audit Report, “Review of Medicaid Disproportionate Share Hospital Payments to University Hospital, University of Medicine and Dentistry of New Jersey: July 1, 1995, Through June 30, 2001.” The Audit revealed hundreds of millions in overpayments over a 5 year period due to the miscalculation of acute care DSH claims. The [...]
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The pharmaceutical industry is attempting to curtail the success of the federal False Claims Act by discouraging its application and expansion to additional states. While big pharma lawyers argue that these cases are nothing more than a “lottery ticket,” Jill Kozeny, Senator Grassley’s spokeswoman, attributes the recovery of “billions of dollars that would have been [...]
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