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.

Posts tagged as:

kickbacks

Medicare Fraud Strike Force Charges 30 Individuals with Medicare Fraud and Expands Operations

by Nolan and Auerbach on January 12, 2010

Thanks to the Medicare Fraud Strike Force, 30 people have been charged in three cities for their alleged roles in schemes to submit more than $61 million in false Medicare claims, according to a Dec. 15, 2009 press release by the Federal Bureau of Investigation (FBI). These individuals who were charged are accused of various [...]

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Nation’s Largest Inpatient Rehab Services Provider Allegedly Paid Illegal Kickbacks to L.A. Orthopedic Clinic

by Nolan and Auerbach on December 4, 2009

HealthSouth Corporation, the nation’s largest provider inpatient rehabilitative healthcare services, allegedly paid illegal kickbacks to the Kerlan Jobe Orthopedic Clinic, a sports medicine clinic in Los Angeles. As a result, the Kerlan Jobe Orthopedic Clinic has agreed to pay the United States $3 million to settle these allegations, the United States Department of Justice announced [...]

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Medicare Fraud Boosts Home Health Spending, According to New GAO Report

by Nolan and Auerbach on March 13, 2009

Medicare spending on home health was $12.9 billion in 2006—that’s up 44% since 2002, according to Government Accountability Office (GAO) report released March 13, 2009. Upcoding, by home health agencies, as well as other fraudulent and abusive practices, such as kickbacks and billing for services not rendered, contributed to the rise in Medicare spending for [...]

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Medicare Scam Results in Indictment of California Doctor and Employee

by Nolan and Auerbach on September 24, 2007

Dr. Kenneth Ferguson, a physician of record at Huntington Beach Medical Center which operated from July through October 2004 was indicted by a federal grand jury in Santa Ana, California along with his employee Olena Kulakova for health care fraud. According to the allegations, Dr. Ferguson and his employee Kulakova would bill Medicare for physician [...]

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Medical Biller Nabbed in Medicare Fraud Scheme

by Nolan and Auerbach on March 20, 2007

An owner of All Medical Billing Solutions, Inc (All Medical Billing) located in Miami, Florida, was sentenced to 10 years imprisonment after being convicted of conspiracy to defraud Medicare, pay health care kickbacks and laundering health care fraud proceeds.  Sotto’s company submitted fraudulent Project New Hope (a Miami HIV medical clinic) claims to Medicare in [...]

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New York Hospital Appears to be Under Investigation for Possible Health Care Fraud and Kickbacks

by Nolan and Auerbach on March 14, 2007

Westchester Medical Center received a subpoena on January 31, 2007 from Office of Inspector General of the U.S. Department of Health and Human Services, asking for information going back to 1997, primarily related to the hospital’s relationships with its doctors.  Under Stark and  anti-kickback laws, hospitals are not permitted to give physicians inducements for patient [...]

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Medicare Fraud – Motorized Wheelchairs

by Nolan and Auerbach on August 8, 2006

An Arkansas physician was sentenced to prison for his role in a Medicare fraud case involving motorized wheelchairs. The physician convinced his elderly patients to seek motorized wheelchairs which were paid for with Government funds. The wheelchair supplier was allegedly paid kickbacks as part of the scheme. For more information,  click here.

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Big Fines Levied For Violations of False Claims Act

by Nolan and Auerbach on May 10, 2006

In an article that appeared in The Baltimore Sun (Jonathan D. Rockoff, Improper sales of medicines targeted; Drug firms have paid fines of $3.5 billion since 2001 for wrongful promotions, The Baltimore Sun, May 7, 2006 at 1A), it is reported that since 2001, pharmaceutical companies prosecuted under the False Claims Act have paid nearly [...]

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