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.

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Florida

Wellcare to Pay $80 Million in Medicaid Fraud Case

by Nolan and Auerbach on May 6, 2009

Executives and employees at WellCare Health Plans Inc. engaged in an elaborate scheme to defraud the Florida Medicaid program and the Florida Healthy Kids Corporation, according to a press release by the U.S. Department of Justice. In order to avoid a health care fraud conviction on these charges WellCare must, among other things, consent to [...]

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South Florida Company Bilks Medicare Out of $170 Million

by Nolan and Auerbach on August 28, 2007

R&I Billing was charged with fraudulently billing Medicare $170 million for infusions of HIV drugs. The scheme worked as follows: “From roughly October 2002 through April 2006, HIV clinics in South Florida serviced by R&I Billing allegedly provided bills to Medicare that indicated patients were being injected with excessive amounts of HIV medications…Based on claims [...]

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South Florida Medicare Fraud Causes Government to Take A Closer Look

by Nolan and Auerbach on June 4, 2007

Federal officials have documented in excess of $140 million in Medicare fraud in South Florida alone.  With 38 arrests in a recent sting operation, the government has said it will take a closer look at other providers of medical equipment.  Health and Human Services Mike Leavitt has said that increased enforcement efforts nationally could save [...]

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CMS Steps Up Efforts to Ferret Out Fraud -Southern Florida is mentioned

by Nolan and Auerbach on October 24, 2006

CMS recently announced multiple accomplishments and projects, all designed to reduce fraud and abuse: the Los Angeles office of CMS revoked the billing numbers of 117 providers who had presented false claims or suspicious business operations, saving $200 million, editing the system to stop payment on claims using billing numbers from deceased providers saved another [...]

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