Medicare Fraud 101 » False Claims

Hospitals in Seven States to Pay more than $9.4 Million for Unnecessary Inpatient Kyphoplasties

Nolan and Auerbach — Tue, 18 May 2010 16:05:14 +0000

Nine hospitals in seven states will pay the U.S. more than $9.4 Million to settle allegations that the health care facilities submitted false claims to Medicare, the U.S. Department of Justice announced May 17, 2010.

The hospitals are alleged to have overcharged Medicare between 2000 and 2008 when performing kyphoplasty, a minimally-invasive procedure used to treat certain spinal fractures. The hospitals performed the procedure on an in-patient, rather than less expensive outpatient basis, in order to increase their Medicare billings.

The settling facilities and the amount being paid by each to the United States are Ball Memorial Hospital, Muncie, Ind. ($1,995,431); Bethesda Memorial Hospital, Boynton Beach, Fla. ($356,079); Bloomington Hospital, Bloomington, Ind. ($1,443,848); Genesys Regional Medical Center, Grand Blanc, Mich. ($931,742); Huntsville Hospital, dba The Health Care Authority of the City of Huntsville, Huntsville, Ala. ($1,992,756); Palmetto Health dba Palmetto Health Baptist Hospital, Columbia, S.C. ($1,861,083.14); St. Elizabeth Medical Center, Utica, N.Y. ($195,976); St. Mary’s of Michigan Hospital, Saginaw, Mich. ($260,065.21); and United Hospital, St. Paul, Minn. ($428,656).

The government settled Medicare fraud cases in 2009 with nine other hospitals for kyphoplasty-related claims, as well as settled for $75 million in 2008 with Medtronic Spine LLC, corporate successor to Kyphon Inc., for causing the Kyphoplasty – related claims. Whistleblowers, or qui tam relators, helped to expose the alleged wrongdoing.

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

Rush University Medical Center to Pay More than $1.5 Million

Nolan and Auerbach — Tue, 30 Mar 2010 15:51:12 +0000

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.

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

Nolan and Auerbach — Mon, 25 Jan 2010 03:44:52 +0000

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.

Hospitals Accused of $50 Million Medicare Fraud

Nolan and Auerbach — Mon, 19 Jan 2009 17:44:37 +0000

Albany N.Y.—According to The Associated Press, recent lawsuits allege that four New York hospitals (Columbia Memorial Physicians Hospital, Long Beach Medical Center, New York Downtown Hospital, St. Joseph’s Medical Center) paid kickbacks to elicit patients for drug treatment programs and billed Medicaid for unnecessary services that lacked state certification. Separately, the suits accuse four of the hospitals of engaging in a kickback scheme to illegally refer patients to the hospitals’ detox units. In a related series of events, Queens’ Parkway Hospital, Our Lady of Mercy, and Benedictine Hospital were accused of paying people to solicit homeless individuals for a three-day detox unit in exchange for cigarettes, beer, food, and other items. Several of the alleged hospitals were aided by SpecialCare Hospital Management Corp., who illegally referred patients for a fee.

Collectively, the aforementioned hospitals fraudulently billed Medicaid for more than $50 million over a total of 14,000 different claims. Attorney General Andrew Cuomo asserts that these hospitals have violated New York’s anti-kickback laws, which prohibit individuals or entities from knowingly and willfully offering, paying, soliciting or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid or any other federally funded program (except the Federal Employees Health Benefits Program).. As of now, the state has settled for $4.5 million with Our Lady of Mercy, which denies any wrongdoing. Likewise, the other hospitals and their management companies have denied all charges and filed motions to have the cases dismissed.
To learn more go here or if you have a Medicare Fraud or False Claims Act case contact Nolan & Auerbach P.A.

Scooter Store Gets Caught Scooting Medicare

Nolan and Auerbach — Fri, 25 May 2007 17:32:25 +0000

In order to settle allegations that the Scooter Store submitted false claims to Medicare, the New Braunfels, Texas company agreed to pay the federal government $4 million and forego another $13 million in Medicare payments. The payments resolve several lawsuits including a whistleblower complaint from a former Scooter Store employee. The whistleblower will receive $3.2 million from the government. According to the Department of Justice, “The Scooter Store engaged in a multimedia advertising campaign to entice beneficiaries to obtain power scooters paid for by Medicare, Medicaid, and other insurers…Instead of the ‘zippy’ power scooters that were advertised, the Scooter Store sold the beneficiaries expensive power wheelchairs that they did not want, need, and/or could not use.” ”This settlement is part of our ongoing commitment to fighting abuse of Medicare’s durable medical equipment benefit,” said Assistant Attorney General Peter D. Keisler.

To read more click on this story click here and also see Nolan Law Firm for more information about whistleblowers and medicare fraud.

Medical Supply Company Owner Sentenced for Medicare Fraud

Nolan and Auerbach — Thu, 30 Nov 2006 15:52:18 +0000

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.