Medicare Fraud 101 » health care http://medicare-fraud.net Medicare Fraud News, Breaking Headlines and Insight from the Qui Tam Perspective Fri, 03 Feb 2012 22:32:12 +0000 en hourly 1 http://wordpress.org/?v=3.2 Hospitals in Seven States to Pay more than $9.4 Million for Unnecessary Inpatient Kyphoplasties http://medicare-fraud.net/hospitals-in-seven-states-to-pay-more-than-9-4-million-for-unnecessary-inpatient-kyphoplasties/ http://medicare-fraud.net/hospitals-in-seven-states-to-pay-more-than-9-4-million-for-unnecessary-inpatient-kyphoplasties/#comments Tue, 18 May 2010 16:05:14 +0000 Nolan and Auerbach http://medicare-fraud.net/hospitals-in-seven-states-to-pay-more-than-9-4-million-for-unnecessary-inpatient-kyphoplasties/ Nine hospitals in seven states will pay the U.S. more than $9.4 Million to settle allegations that the health care facilities submitted false claims to Medicare, the U.S. Department of Justice announced May 17, 2010.

The hospitals are alleged to have overcharged Medicare between 2000 and 2008 when performing kyphoplasty, a minimally-invasive procedure used to treat certain spinal fractures. The hospitals performed the procedure on an in-patient, rather than less expensive outpatient basis, in order to increase their Medicare billings.

The settling facilities and the amount being paid by each to the United States are Ball Memorial Hospital, Muncie, Ind. ($1,995,431); Bethesda Memorial Hospital, Boynton Beach, Fla. ($356,079); Bloomington Hospital, Bloomington, Ind. ($1,443,848); Genesys Regional Medical Center, Grand Blanc, Mich. ($931,742); Huntsville Hospital, dba The Health Care Authority of the City of Huntsville, Huntsville, Ala. ($1,992,756); Palmetto Health dba Palmetto Health Baptist Hospital, Columbia, S.C. ($1,861,083.14); St. Elizabeth Medical Center, Utica, N.Y. ($195,976); St. Mary’s of Michigan Hospital, Saginaw, Mich. ($260,065.21); and United Hospital, St. Paul, Minn. ($428,656).

The government settled Medicare fraud cases in 2009 with nine other hospitals for kyphoplasty-related claims, as well as settled for $75 million in 2008 with Medtronic Spine LLC, corporate successor to Kyphon Inc., for causing the Kyphoplasty – related claims. Whistleblowers, or qui tam relators, helped to expose the alleged wrongdoing.

For the full release click here.  For more information about qui tam law and Medicare fraud, contact Nolan and Auerbach, PA.

]]> http://medicare-fraud.net/hospitals-in-seven-states-to-pay-more-than-9-4-million-for-unnecessary-inpatient-kyphoplasties/feed/ 0 President’s Proposed 2010 Budget Aims to Increase Revenue by Reducing Fraud, Abuse http://medicare-fraud.net/presidents-proposed-2010-budget-aims-to-increase-revenue-by-reducing-fraud-abuse/ http://medicare-fraud.net/presidents-proposed-2010-budget-aims-to-increase-revenue-by-reducing-fraud-abuse/#comments Wed, 03 Feb 2010 18:16:50 +0000 Nolan and Auerbach http://medicare-fraud.net/?p=273 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 at reducing Medicare and Medicaid fraud, waste and abuse by, inter alia, increasing oversight and use of national coding and technology to ensure appropriate Medicare payments for imaging and more. It also proposes to address financial conflicts of interest in physician-owned specialty hospitals. This is another firm indication that President Obama is well aware that investing in fraud detection and enforcement will return taxpayer dollars many times over.

To review the budget outline, go to http://www.whitehouse.gov/omb/budget/. Or, for more information about Medicare fraud, contact Nolan and Auerbach, PA.

]]> http://medicare-fraud.net/presidents-proposed-2010-budget-aims-to-increase-revenue-by-reducing-fraud-abuse/feed/ 0 New Report Suggests Waste, Including Health Care Fraud, Is One Third the Health Care Budget http://medicare-fraud.net/new-report-suggests-waste-including-health-care-fraud-is-one-third-the-health-care-budget/ http://medicare-fraud.net/new-report-suggests-waste-including-health-care-fraud-is-one-third-the-health-care-budget/#comments Sat, 31 Oct 2009 00:11:52 +0000 Nolan and Auerbach http://medicare-fraud.net/?p=242 Keith Olbermann reported on MSNBC’s Countdown October 27 that President Obama has said that eliminating waste could pay for most of any health care reform package. But critics disagree. Those critics might be more than a little wrong. Olbermann says a new study suggests the President might have underestimated just how much waste there is. The U.S. Health care system wastes $505 billion, perhaps $850 billion, every year. This is according to an independent study by Thomson Reuters.

The report, released October 26, 2009 by Thomson Reuters, attributes most of the waste to unnecessary care, such as the overuse of medications and diagnostic tests. The next largest category of waste is health care fraud, which according to the report, costs $125 billion to $175 billion each year and includes everything from fraudulent Medicare claims to kickbacks for referrals for unnecessary services.

The bad news is that one-third of our health care budget in America is spent on waste. The good news is that this is something we can change and that reporting health care fraud is a significant step in that direction.

For the full Thomson Reuters release, go to: http://thomsonreuters.com/content/press_room/tsh/waste_US_healthcare_system.

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

]]> http://medicare-fraud.net/new-report-suggests-waste-including-health-care-fraud-is-one-third-the-health-care-budget/feed/ 0 Inspector general addresses health care fraud http://medicare-fraud.net/inspector-general-addresses-health-care-fraud/ http://medicare-fraud.net/inspector-general-addresses-health-care-fraud/#comments Fri, 26 Jun 2009 15:17:32 +0000 Nolan and Auerbach http://medicare-fraud.net/?p=213 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. 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/.

]]> http://medicare-fraud.net/inspector-general-addresses-health-care-fraud/feed/ 0 Miamians Charged in Elaborate Medicare Fraud http://medicare-fraud.net/miamians-charged-in-elaborate-medicare-fraud/ http://medicare-fraud.net/miamians-charged-in-elaborate-medicare-fraud/#comments Wed, 24 Jun 2009 15:04:46 +0000 Nolan and Auerbach http://medicare-fraud.net/?p=209 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 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.

]]> http://medicare-fraud.net/miamians-charged-in-elaborate-medicare-fraud/feed/ 0 Double-billing Settlement Highlights Whistleblower Concerns http://medicare-fraud.net/double-billing-settlement-highlights-whistleblower-concerns/ http://medicare-fraud.net/double-billing-settlement-highlights-whistleblower-concerns/#comments Tue, 23 Jun 2009 14:33:59 +0000 Nolan and Auerbach http://medicare-fraud.net/?p=206 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 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.

]]> http://medicare-fraud.net/double-billing-settlement-highlights-whistleblower-concerns/feed/ 0 UMDNJ to Pay U.S. $2 Million for Allegations of Medicare Fraud http://medicare-fraud.net/umdnj-to-pay-us-2-million-for-allegations-of-medicare-fraud/ http://medicare-fraud.net/umdnj-to-pay-us-2-million-for-allegations-of-medicare-fraud/#comments Wed, 10 Jun 2009 01:37:21 +0000 Nolan and Auerbach http://medicare-fraud.net/?p=203 The University of Medicine and Dentistry of New Jersey (UMDNJ) has agreed to pay the United States $2 million to resolve federal civil fraud allegations that its hospital defrauded Medicaid, the Justice Department announced June 9, 2009, according to a press release on PR Newswire.

From 1993 to 2004, UMDNJ’s University Hospital submitted claims to Medicaid for outpatient physician services that were also being billed by doctors working in the hospital’s outpatient centers. By submitting duplicate claims for payment, University Hospital doubled billed the government’s Medicaid program, according to the release.

The case against UMDNJ and University Hospital originated in a qui tam, or whistleblower, complaint filed under the Federal False Claims Act.

For the entire press release, go to: http://news.prnewswire.com/DisplayReleaseContent.aspx?ACCT=104&STORY=/www/story/06-09-2009/0005041208&EDATE.

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

]]> http://medicare-fraud.net/umdnj-to-pay-us-2-million-for-allegations-of-medicare-fraud/feed/ 0 Alleged False Claims Act Violations Land Minnesota Hospitals in Hot Water http://medicare-fraud.net/alleged-false-claims-act-violations-land-minnesota-hospitals-in-hot-water/ http://medicare-fraud.net/alleged-false-claims-act-violations-land-minnesota-hospitals-in-hot-water/#comments Fri, 22 May 2009 17:06:53 +0000 Nolan and Auerbach http://medicare-fraud.net/?p=195 Three HealthEast Care System hospitals have agreed to pay the United States $2.28 million to settle allegations that the health care facilities submitted false claims to Medicare, the U.S. Justice Department announced May 21, 2009.

According to the DOJ press release, the settlement resolves allegations that the St. Paul, Minn.-based hospitals overcharged Medicare from 2002 to 2007 by thousands of dollars each time they performed kyphoplasty, a minimally-invasive procedure used to treat certain spinal fractures that often are due to osteoporosis. The procedure can be performed safely as an outpatient surgery, but the government contends that the HealthEast hospitals performed the procedure on an inpatient basis in order to increase their Medicare billings.

The settlement with HealthEast follows the government’s May 2008 settlement with Medtronic Spine LLC, corporate successor to Kyphon Inc. Medtronic Spine paid $75 million to settle allegations that the company defrauded Medicare by counseling hospital providers to perform kyphoplasty procedures as an inpatient procedure.

The qui tam or whistleblower lawsuit against the HealthEast hospitals was brought under the False Claims Act.

To read the full press release, go to: http://www.usdoj.gov/opa/pr/2009/May/09-civ-497.html.

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

]]> http://medicare-fraud.net/alleged-false-claims-act-violations-land-minnesota-hospitals-in-hot-water/feed/ 0 Homecare Association Presents 13-point Plan to Eliminate Medicare Waste, Fraud and Abuse http://medicare-fraud.net/homecare-association-presents-13-point-plan-to-eliminate-medicare-waste-fraud-and-abuse/ http://medicare-fraud.net/homecare-association-presents-13-point-plan-to-eliminate-medicare-waste-fraud-and-abuse/#comments Thu, 07 May 2009 15:11:42 +0000 Nolan and Auerbach http://medicare-fraud.net/?p=183 In April 2009, the American Association for Homecare presented Congress with its 13-point legislative action plan, called the Medicare Anti-Fraud Legislative Plan, aimed at eliminating waste, fraud and abuse in Medicare’s home medical equipment sector.

The plan’s steps, according to the homecare association, would eliminate most of the Medicare fraud attributed to the home medical equipment sector by attacking the problem at the front of the process rather than relying on the “pay-and-chase” approach to stop fraud.  Included in the recommendations: mandate site inspections for all new home medical equipment providers and require site inspections for all home medical equipment provider renewals.

We applaud this Association for its efforts. Its members and taxpayers would be well served if some of the Plan is adopted by congress.

For more information on the American Association for Homecare’s plan, go to www.aahomecare.org/stopfraud. For a press release on the topic, go to http://news.prnewswire.com/DisplayReleaseContent.aspx?ACCT=104&STORY=/www/story/04-22-2009/0005011280&EDATE. And for more information about qui tam law and health care fraud, contact Nolan and Auerbach, PA.

]]> http://medicare-fraud.net/homecare-association-presents-13-point-plan-to-eliminate-medicare-waste-fraud-and-abuse/feed/ 0 Wellcare to Pay $80 Million in Medicaid Fraud Case http://medicare-fraud.net/wellcare-to-pay-80-million-in-medicaid-fraud-case/ http://medicare-fraud.net/wellcare-to-pay-80-million-in-medicaid-fraud-case/#comments Wed, 06 May 2009 14:49:45 +0000 Nolan and Auerbach http://medicare-fraud.net/?p=180 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 the civil forfeiture of $40,000,000 and pay an additional $40,000,000 in restitution to the Florida Medicaid and Healthy Kids programs to repay proceeds from those programs to which WellCare was not entitled, according to the release.

The St. Petersburg Times newspaper described this investigation in a May 6 online article as “one of the largest health care fraud cases in the United States.”

To read the press release, go to: http://www.usdoj.gov/usao/flm/pr/2009/may/20090505_WELLCARE_Tpa_HCFraudDPA.pdf. To read the St. Petersburg Times article, go to: http://www.tampabay.com/news/business/article998325.ece. And for more information about qui tam law and health care fraud, contact Nolan and Auerbach, PA.

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