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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healthcare fraud

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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Physicians Snared By Growing Medicare Fraud Strike Team

by admin on July 15, 2009

Marcella Auerbach was quoted by Amy Lynn Sorrel in her article “Physicians snared by growing Medicare fraud strike team,” which appeared in the July 6 online edition of American Medical News. The article discussed the announcement by the Department of Justice and Health & Human Services that criminal charges were filed against 53 doctors and [...]

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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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Sheehan Calls for Aggressive Actions against Medicare, Medicaid Fraud and Abuse

by Nolan and Auerbach on April 23, 2009

On April 22, 2009,  New York Medicaid Inspector General James Sheehan testified before the U.S. Senate Committee on Homeland Security and Governmental Affairs Subcommittee on Medicare and Medicaid about waste and fraud. New York was the most successful state in the nation in Medicaid program integrity in the past year, measured by fraud and abuse [...]

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New York Hospital Agrees to Settle Qui Tam

by Nolan and Auerbach on March 6, 2009

The Government announced today that a former employee  of Victory Memorial Hospital’s qui tam lawsuit has resulted in a settlement with the United States of at least $2.3 million to resolve claims that the hospital defrauded the Medicare program. The Medicare Fraud settlement covers allegations that Victory Memorial submitted Cost Reports for 1996 and 1997 [...]

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

by Nolan and Auerbach on March 5, 2009

President Obama’s fiscal year 2010 proposed budget estimates that reducing health care fraud, waste and abuse could save the government about $5 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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How to be a Successful Whistleblower Under the False Claims Act and Still Have Money for Lunch

by Nolan and Auerbach on December 28, 2006

A corporate insider is in a unique position to know the details about how their employer has cheated the United States Government. Nothing beats the knowledge an insider can impart. Whistleblowers are the real heroes in the fight against fraud. The person (plaintiff) who brings an action under the False Claims Act is called a [...]

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