The GAO strategies should be implemented by the Department of Health and Human Services and its components, the OIG and CMS. The strategies are intended to ward off fraud before it happens, something which will benefit taxpayers in the long run. Medicare and Medicaid has too long been a pay and chase reimbursement system.

For the GAO Report or information about qui tam law and Medicare fraud, contact Nolan and Auerbach, PA.

For more information about qui tam law and Medicare fraud, contact Nolan and Auerbach, PA.

Additional Reference Links:

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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.

He said such payments, which include Medicare fraud and Medicaid fraud, amounted to more than is spent on the Education Department and the Small Business Administration combined, according to the article.

Obama’s anti-fraud approach includes hiring private auditing firms, called Recovery Audit Contractors, or RACs, to comb health care businesses—including doctors’ practices—for health care fraud and abuse. The auditors, like whistleblowers or qui tam relators, would keep part of what they help to recover.

The White House said a Medicare pilot program, using such auditors, recouped $900 million for taxpayers from 2005-08, according to AP. We think the RAC’s provide a huge savings to taxpayers at minimum just because of the deterrent effect alone. It is our understanding that health systems are generally aware of upcoming audits and their scope. The recoveries they have centered on medical necessity of inpatient admissions, an area we believe will be an upcoming focus of the OIG.

Click here here for the full story.  For more information about qui tam law and Medicare  fraud, contact Nolan and Auerbach, PA.

The claims arise from allegations that the company illegally imported unapproved medical devices and provided them to physicians for use in patients; committed fraud in a clinical study by failing to comply with federal regulations; and promoted certain products for procedures for which the company had not received Food and Drug Administration approval or clearance.

The company manufactures, distributes and sells certain medical lasers and peripheral devices for those lasers, such as lead wires that guide the lasers through vascular tissue and catheters that carry and contain the lasers inside the veins, including, specifically, the CVX-300 Medical Laser and the CliRpath Turbo Laser Catheter, the TURBO Elite Laser Ablation Catheter, and the TURBO-Booster Laser Guide Catheter, according to the DOJ.

To read the full press release, go to: http://www.justice.gov/opa/pr/2009/December/09-civ-1385.html.

For more information about qui tam and health care fraud, contact Nolan and Auerbach, PA.

The settlement resolves allegations that HealthSouth paid kickbacks to Kerlan Jobe in the form of stock option grants, donations to the Kerlan Jobe Foundation, loan forgiveness on an equipment lease, and a disproportionately high ownership interest in a jointly owned ambulatory surgery center. In exchange for the illegal kickbacks, Kerlan Jobe allegedly referred patients to HealthSouth facilities. As a condition of continued participation in government healthcare programs, Kerlan Jobe was required to enter into a Corporate Integrity Agreement with the Office of Inspector General of the Department of Health and Human Services to address Kerlan Jobe’s financial relationships with referral recipients.

For the full release, go to: http://www.justice.gov/opa/pr/2009/December/09-civ-1294.html.

For more information about qui tam and health care fraud, contact Nolan and Auerbach, PA. 

Right now, federal law requires that Medicare send payment within a very short time frame, even when there is risk of fraud, waste or abuse.

The bill Grassley introduced on November 16 – the Fighting Medicare Payment Fraud Act of 2009 – would give the Secretary of Health and Human Services authority to extend the time period in which payments must be made under the prompt payment rule if the Secretary determines there is a likelihood of fraud, waste or abuse. With this additional time, the Secretary would be required to conduct more detailed reviews of the claims in question to make sure they are supposed to be paid.

The Grassley bill also requires the experts in the Office of Inspector General to recommend, on at least an annual basis, categories of providers or suppliers where additional scrutiny is needed before payments are made under the prompt payment rule. To make sure there is action on these recommendations, the Secretary would be required to provide a response to the Inspector General on these recommendations, according to the release.

For the full press release, go to: http://www.iowapolitics.com/index.iml?Article=177068.

For information about qui tam law and health care fraud, contact Nolan and Auerbach, PA.

Talking before the Subcommittee on Health of the House Energy and Commerce Committee Levinson, inspector general of the U.S. Department of Health and Human Services (HHS), said these recommendations were based on OIG’s evaluations, investigations and audits on issues, such as fraudulent activity by health care providers; excessive payments for medical services, equipment, and prescription drugs; and financial conflicts of interests within the institutions charged with protecting the health of the American public.

He emphasized that collaboration and innovation are essential in the fight against fraud. Levinson cited the launch of Health Care Fraud Prevention and Enforcement Action Team (HEAT), a joint task force consisting of OIG and Department of Justice senior leadership.

The inspector general identified health care vulnerabilities to fraud and waste and outlined OIG’s program to strengthen the integrity of government-run health care, called the Five-Principle Strategy to Combat Health Care Fraud, Waste, and Abuse.

For the full testimony, go to: http://www.oig.hhs.gov/testimony/docs/2009/06252009_testimony_health_reform.pdf.

For more information about qui tam law and health care fraud, contact Nolan and Auerbach, PA. http://www.whistleblowerfirm.com/.

The sophisticated scheme involved fake clinics, which in reality were empty storefronts or post office boxes–none providing any actual medical services. The defendants face charges ranging from conspiracy to commit Medicare fraud and money laundering to aggravated identity theft. If convicted, the defendants could get prison time and have to forfeit their profits, according to Reuters.

For the full story, go to: http://www.reuters.com/article/latestCrisis/idUSN23304580.

For more information about qui tam law and health care fraud, contact Nolan and Auerbach, PA.

The settlement was the second time UMDNJ paid the government for the double-billing scheme. The first was in 2005 when the hospital paid $4.9 million to the state of New Jersey to settle criminal charges.

In the end, UMDNJ ended up paying nearly $7 million total for the scheme, but, according to Marcella Auerbach, managing partner at Nolan & Auerbach, the hospital could have avoided the lengthy and costly litigation and saved millions, if it had acted differently.

According to Auerbach, a former federal prosecutor who now exclusively represents whistleblowers in healthcare fraud cases, UMDNJ’s in-house attorney discovered the hospital and its physicians were billing for the same services back in 2001-before any whistle was blown. The lawyer brought the issue to the hospital’s attention, but the management looked the other way, and continued to double-bill for the three years following the warning, he says.

The fact that UMDNJ knew about the double-billing, knew it was illegal, and continued to do it, is what makes the case so interesting. According to Auerbach, the hospital could have saved millions if it ceased double-billing and came clean to the government through a self-disclosure.

“It’s a bet,” Auerbach says. “They are betting on the fact they won’t get caught.”

However, UMDNJ hit one too many times and ended up going bust. The man who busted the hospital is Steven Simring, MD, who will collect $801,000 for his efforts.

Based on the details of the case, Auerbach was not surprised to see a doctor blow the whistle on the hospital. Evidence shows that there were many discussions about the double-billing in which doctors expressed concern. Auerbach says it comes as no surprise that Simring would come forward and blow the whistle rather than risk being prosecuted himself.

Auerbach, who has extensive experience in whistleblower cases, says the gambler’s mind-set is common in whistleblower cases. Rather than play by the rules and fess up, many facilities try to sweep problems under the rug and pretend they never happened. Some even go one step further. Auerbach says many times concerned employees will raise a compliance concern only to be handed a pink slip for their trouble, which raises another legal problem.

“These people are fired for bringing points up,” Auerbach says, “Then they come to us and they have two claims.”

Auerbach says this case can be seen as a message to healthcare leaders. The DOJ is saying take any compliance concerns presented by employees or legal council very seriously and, when appropriate, self-disclose. The alternative is a lengthy, expensive, public whistleblower case.

For the entire article, go to: http://www.healthleadersmedia.com/content/234437/topic/WS_HLM2_FIN/Doublebilling-Settlement-Highlights-Whistleblower-Concerns.html

For more information about qui tam law and health care fraud, contact Nolan and Auerbach, PA.