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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fraud

GAO Identifies Five Strategies to Fight Medicare Fraud, Waste, Abuse

by Nolan and Auerbach on June 17, 2010

On June 15, 2010, the U.S. Government Accountability Office (GAO) released a report identifying five important areas for preventing Medicare fraud, waste and abuse. The strategies in this new report, “Medicare Fraud, Waste, and Abuse: Challenges and Strategies for Preventing Improper Payments,” are: (1) Strengthening the provider enrollment process and standards; (2) Improving the pre-payment [...]

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OIG Site Recognizes MFCU’s

by Nolan and Auerbach on April 26, 2010

Many Medicare Fraud cases are jointly worked by the feds and the states, as often the cases  are national in scope and involve Medicaid utilization as well as Medicare. To display  the often important role played by State Medicaid Fraud Control Units (MFCUs), the OIG has developed a new section on its website specifically concerning [...]

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

by Nolan and Auerbach on March 22, 2010

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 [...]

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President Denounces Health Care Fraud Yesterday

by Nolan and Auerbach on March 11, 2010

During a March 10, 2010 rally in St. Charles, Mo., President Obama blamed health care fraud, waste and abuse for costing taxpayers almost $100 billion in 2009, according to an Associated Press story published that day on Yahoo News. He said such payments, which include Medicare fraud and Medicaid fraud, amounted to more than is [...]

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Spectranetics Corporation to Pay $5 Million to Resolve Allegations of Health Care Fraud

by Nolan and Auerbach on January 7, 2010

Spectranetics Corporation, a medical device manufacturer, has agreed to pay the United States $4.9 million in civil damages, as well $100,000 forfeiture to resolve claims against the company, the United States Department of Justice (DOJ) announced December 29, 2009. The claims arise from allegations that the company illegally imported unapproved medical devices and provided them [...]

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Nation’s Largest Inpatient Rehab Services Provider Allegedly Paid Illegal Kickbacks to L.A. Orthopedic Clinic

by Nolan and Auerbach on December 4, 2009

HealthSouth Corporation, the nation’s largest provider inpatient rehabilitative healthcare services, allegedly paid illegal kickbacks to the Kerlan Jobe Orthopedic Clinic, a sports medicine clinic in Los Angeles. As a result, the Kerlan Jobe Orthopedic Clinic has agreed to pay the United States $3 million to settle these allegations, the United States Department of Justice announced [...]

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Grassley Introduces Bill to Fight Medicare Fraud

by Nolan and Auerbach on November 16, 2009

Working to protect taxpayers and Medicare beneficiaries, U.S. Senator Chuck Grassley has introduced legislation to give the federal government more time to pay Medicare providers when waste, fraud and abuse is suspected, according to a November 16, 2009 press release on IowaPolitics.com. Right now, federal law requires that Medicare send payment within a very short [...]

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Inspector general addresses health care fraud

by Nolan and Auerbach on June 26, 2009

On Thursday, June 25, 2009, Daniel R. Levinson presented testimony on the Office of the Inspector General’s (OIG’s) role in addressing health care waste, fraud and abuse, as well as its plans for health care reform. Talking before the Subcommittee on Health of the House Energy and Commerce Committee Levinson, inspector general of the U.S. [...]

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Miamians Charged in Elaborate Medicare Fraud

by Nolan and Auerbach on June 24, 2009

Federal prosecutors charged eight conspirators in Miami with defrauding the U.S. healthcare system by creating phony clinics that churned out $100 million of medical bills in five states, according to a June 23, 2009 Reuters news article. The sophisticated scheme involved fake clinics, which in reality were empty storefronts or post office boxes–none providing any [...]

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Double-billing Settlement Highlights Whistleblower Concerns

by Nolan and Auerbach on June 23, 2009

Earlier this week, the University of Medicine and Dentistry of New Jersey agreed to pay the federal government $2 million to settle a whistleblower lawsuit alleging that it bilked Medicaid in a double-billing scheme that started in 1993 and ended in 2003, according to the Department of Justice. The settlement was the second time UMDNJ [...]

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