Medicare Fraud 101 » lawsuit http://medicare-fraud.net Medicare Fraud News, Breaking Headlines and Insight from the Qui Tam Perspective Thu, 09 Sep 2010 19:41:59 +0000 http://wordpress.org/?v=2.9.2 en hourly 1 Teaching Hospital Settles Physician Billing Case http://medicare-fraud.net/teaching-hospital-settles-physician-billing-case/ http://medicare-fraud.net/teaching-hospital-settles-physician-billing-case/#comments Thu, 16 Jul 2009 19:11:03 +0000 Nolan and Auerbach http://medicare-fraud.net/?p=222 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 on behalf of physicians who were not present when residents performed the procedures.

 

LSUHSC-S agreed to pay more than $700,000 to resolve the False Claims Act allegations. The complaint was initiated by two employees-turned-whistleblowers who both plan to file another suit to collect lost wages, benefits, and damages for their damaged reputations.

 

Ken was quoted on the connection between this settlement and Physicians at Teaching Hospitals (PATH), the Department of Justice (DOJ) and Office of Inspector General’s (OIG) national enforcement project in the area of teaching physicians. While the goal of PATH was to target major offenders, Ken does not find it surprising that smaller offenders like LSUHSC-S are showing up with independent whistleblower cases. This is one of the several beneficial scenarios to taxpayers that the qui tam law was intended to capture. Ken also highlighted that many settlements are now originated with whistleblowers, instead of the DOJ or OIG like with PATH.

]]> http://medicare-fraud.net/teaching-hospital-settles-physician-billing-case/feed/ 1 Calif. County to Pay U.S. $6.8 Million for Allegations of False Medicare, Medicaid Claims http://medicare-fraud.net/calif-county-to-pay-us-68-million-for-allegations-of-false-medicare-medicaid-claims/ http://medicare-fraud.net/calif-county-to-pay-us-68-million-for-allegations-of-false-medicare-medicaid-claims/#comments Wed, 18 Mar 2009 14:02:37 +0000 Nolan and Auerbach http://medicare-fraud.net/?p=166 The U.S. Department of Justice announced March 12, 2009, that San Mateo County, Calif., will pay the United States $6.8 million to resolve allegations that the San Mateo Medical Center (SMMC) submitted false claims to the United States in connection with payments from the Medicare and Medicaid programs.

The government alleges that SMMC engaged in Medicare Fraud by falsely inflated its bed count to Medicare in order to receive higher payments under Medicare’s Disproportionate Share Hospital (DSH) adjustment. The government also alleges that San Mateo County improperly obtained federal payments under the Medicaid program for services provided to patients at Institutes of Mental Disease (IMDs) who were between the ages of 22 and 64. This is once again an example of a case where the simple manipulation of a few numerals results in overpayments of millions of dollars. The lawsuit was filed under the qui tam or whistleblower provisions of the False Claims Act by a former employee of San Mateo County.

For a copy of the full press release, http://www.usdoj.gov/opa/pr/2009/March/09-civ-224.html. For more information about qui tam whistleblower law, contact Nolan and Auerbach, PA.

]]> http://medicare-fraud.net/calif-county-to-pay-us-68-million-for-allegations-of-false-medicare-medicaid-claims/feed/ 0 Whistleblower Lawsuit Against New Jersey Hospital Results in $3.85 Million Payment for Medicare Fraud http://medicare-fraud.net/whistleblower-lawsuit-against-new-jersey-hospital-results-in-385-million-payment-for-medicare-fraud/ http://medicare-fraud.net/whistleblower-lawsuit-against-new-jersey-hospital-results-in-385-million-payment-for-medicare-fraud/#comments Tue, 04 Nov 2008 17:12:51 +0000 Nolan and Auerbach http://medicare-fraud.net/?p=50 Cooper University Hospital in New Jersey has agreed to pay $3.8 million to the federal government as the result of inflating its Medicare claims from 2001 to 2003.  Specifically the Department of Justice alleged that the hospital improperly increased its charges for inpatient and outpatient care to make it appear that the charges were greater than they actually were.  The whistleblower litigation was brought by Anthony Kite, an independent hospital consultant.

This outlier fraud case involved supplemental payments Medicare makes when a patient exceeds a predetermined payment amount, also known as outlier payments.  Similar lawsuits have been brought against other New Jersey hospitals with equal success as the result of their engaging in Medicare fraud.

To learn more click here or if you have False Claims Act case contact Nolan & Auerbach P.A.

]]> http://medicare-fraud.net/whistleblower-lawsuit-against-new-jersey-hospital-results-in-385-million-payment-for-medicare-fraud/feed/ 0 Home Health Care Industry Riddled With Fraud http://medicare-fraud.net/home-health-care-industry-riddled-with-fraud/ http://medicare-fraud.net/home-health-care-industry-riddled-with-fraud/#comments Mon, 30 Oct 2006 17:50:03 +0000 Nolan and Auerbach http://medicare-fraud.net/?p=10 Marietta Diaz, a former employee of Provident Health Care filed a whistleblower lawsuit against her former employer. Diaz claimed that Provident Home Health Care Services, Inc. and Tri-Regional Home Health Care Inc. billed Medicare for home health services that were never provided. Los Angeles Assistant U.S. Attorney Consuelo Woodhead said that this case is not an isolated one and that the home health industry in Southern California has been experiencing serious problems. Woodhead also said this case brought further attention to the scandals in the business. The settlement in this case led to over $33 million being repaid to the government with Diaz receiving over 20.75% of the recovery or $6,847,500.

For more information please click here.

]]> http://medicare-fraud.net/home-health-care-industry-riddled-with-fraud/feed/ 0