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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health care fraud

President’s Proposed 2010 Budget Aims to Increase Revenue by Reducing Fraud, Abuse

by Nolan and Auerbach on February 3, 2010

President Obama’s fiscal year 2010 proposed budget estimates that reducing health care fraud, waste and abuse could save the government about $10 billion in a decade’s time. The budget pledges nearly $1.5 billion for its Health Care Fraud and Abuse Control Program (HCFAC), including a $311 million increase in HCFAC funding. The budget takes aim [...]

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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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Fighting Medicare Fraud

by Nolan and Auerbach on July 30, 2009

PBS business news correspondent Jeff Yastine interviewed Marcella Auerbach for his broadcast news segment titled, “Dozens Arrested For Medicare Fraud,” which aired nationally during the July 30, 2009 nightly news cast. Marcella was also quoted in Jeff’s related news article titled, “Fighting Medicare Fraud.” In celebration of the 44th anniversary of Medicare, the segment reported [...]

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Florida Medicare Fraud Hits New Low With Fake HIV Clinic

by Nolan and Auerbach on June 15, 2007

Twelve people were arrested in connection with a $5 million scam for collecting Medicare and Medicaid benefits for phony HIV treatments.  The charges included allegations that HIV positive patients were recruited by the Belle Glade Family Health Group and were paid $25 per visit.  In addition, many patients were given vitamin shots instead of the [...]

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