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

Whistleblower Lawsuit Against New Jersey Hospital Results in $3.85 Million Payment for Medicare Fraud

by Nolan and Auerbach on November 4, 2008

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 and Its Doctors Pay Nearly $15 Million Settlement to Government

by Nolan and Auerbach on January 2, 2008

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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How to be a Successful Whistleblower Under the False Claims Act and Still Have Money for Lunch

by Nolan and Auerbach on December 28, 2006

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 Pays $25 Million for False Billings for Neonatal Critical Care when Patients not Critically Ill

by Nolan and Auerbach on October 9, 2006

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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Health Care Employers Required to Educate Employees on False Claims Act Whistleblowing

by Nolan and Auerbach on August 30, 2006

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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South Carolina Medical Center to Pay $3.75 Million Fine

by Nolan and Auerbach on August 23, 2006

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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False Certification Case Settled for $9 million

by Nolan and Auerbach on August 10, 2006

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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Qui Tam Lawsuits Stike Hard at Healthcare Fraud

by Nolan and Auerbach on August 3, 2006

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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New Jersey Hospital Owes the Feds $85.7 Million

by Nolan and Auerbach on July 25, 2006

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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Something to Hide? Big Pharma Attorneys Say “No” to False Claims Act

by Nolan and Auerbach on May 10, 2006

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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