Medicare Fraud 101 » false medicare claims

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.

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

Nolan and Auerbach — Mon, 22 Mar 2010 15:02:31 +0000

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.

Physicians Snared By Growing Medicare Fraud Strike Team

admin — Wed, 15 Jul 2009 19:02:27 +0000

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.