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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Ken Nolan

Teaching Hospital Settles Physician Billing Case

by Nolan and Auerbach on July 16, 2009

In the July 13 edition of the Report on Medicare Compliance, Editor Nina Armstrong quoted Ken Nolan in her article titled, “Teaching Hospital Settles Physician Billing Case, Signs Second Agreement with OIG.” The article reported that Louisiana State University Health Sciences Center in Shreveport (LSUHSC-S) recently settled a dispute alleging it billed Medicare for surgery [...]

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