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.

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

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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.

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.

The Texas hospital allegedly violated the civil False Claims Act by submitting improper claims for payment to the Medicare program between July 1, 2003, and July 1, 2007, for pulmonology-related items and services.

In August 2007, Arlington Memorial’s corporate parent self-disclosed to the Office of Inspector General for the Department of Health and Human Services (OIG) that a long-standing contract with a physician group for the interpretation of arterial blood gas (ABG) tests potentially violated federal law. The U.S. contends that Arlington Memorial Hospital knowingly failed, through the actions of its former president, to eliminate payments to the group for the interpretations of hospital tests that were not performed, and that Arlington Memorial Hospital AMH knew such payments were not in compliance with federal legal requirements, according to the U.S. Department of Justice press release.

For the full release, go to: http://www.justice.gov/usao/txn/PressRel10/arlington_memorial_hospital_settle_pr.html.

For more information about qui tam law 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.

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. 

President Obama’s speech further confirms that the fight against healthcare fraud is a top priority for the government, and its recently heightened efforts to recoup healthcare dollars by prosecuting violators underscores that message. Simply put, in order to afford a viable healthcare system unnecessary spending must be eliminated. We’ve said it before – the government is keeping a watchful eye on Medicare and Medicaid fraud, as well as fraud within the pharmaceutical industry. In fact, just last week the Office of Inspector General announced Medicaid Fraud Control Units recovered $1.3 billion in 2008.

Needing all the help they can get, federal regulators see whistleblowers as crucial players in the fight against healthcare fraud. As Marcella Auerbach pointed out in an interview with PBS in July, the healthcare industry receives a $15 return for every dollar the government spends on efforts to fight fraud. By spotting fraud early on, significant money can be recovered for patients and taxpayers.

For the entire transcript of President Obama’s speech, go to:
http://www.whitehouse.gov/the_press_office/Remarks-by-the-President-to-a-Joint-Session-of-Congress-on-Health-Care/

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