Medicare Fraud News, Breaking Headlines and Insight from the Qui Tam Perspective
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Improperly billed claims paid by Medicaid payments has resulted in a $60 million settlement by CoxHealth. This settlement resulted from allegations that beginning as far back as January 1996, CoxHealth allegedly entered into prohibited financial agreements that violated Medicare cost report requirements, Stark Laws and the Anti-Kickback Statute. John F. Wood, the U.S. Attorney for [...]
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The federal government has instituted a two-year pilot program, in Florida and California, targeting medical equipment suppliers in to root out those who defraud Medicare, by requiring them to reapply to the program. As the result of this program, sellers of durable medical equipment such as providers of artificial limbs, braces, splints and wheelchairs need [...]
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Twelve people were arrested in connection with a $5 million scam for collecting Medicare and Medicaid benefits for phony HIV treatments. The charges included allegations that HIV positive patients were recruited by the Belle Glade Family Health Group and were paid $25 per visit. In addition, many patients were given vitamin shots instead of the [...]
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The Department of Health and Human Services Office of Inspector General Semiannual Report to Congress reports that the OIG will recover nearly $3 billion for Medicare fraud reports that the OIG will recover nearly $3 billion for , Medicaid fraud , and other healthcare federally-funded programs for the first half of fiscal year 2007. The [...]
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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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A federal monitor’s report found that the University of Medicine and Dentistry of New Jersey made since 2002, $5.7 million in illegal payments to physicians in exchange for their heart patient referrals. As the result of these patient referrals, physicians were given “no-show” teaching jobs in excess of $150,000 per year. The monitoring system was [...]
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Employee Section 6032 “Employee Education About False Claims Recovery” requires that entities receiving or making more than $5 million in annual payments under a state Medicaid plan, must, as a condition of participation, create written compliance policies designed to educate employees, contractors and agents about false claims, false statements and whistleblower protections under applicable federal [...]
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As a result of violating Stark Laws and submitting improper bills to Medicare, Medicaid and TRICARE, the Marion County Medical Center in South Carolina will pay $3.75 Million arising out of a qui tam False Claims Act case filed by a whistleblower. For more information click here.
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A May 9, 2006, Los Angeles Times article (Lisa Girion, U.S. Programs May Exclude Tenet Hospital, The Los Angeles Times, May 9, 2006 at C9), it was reported that, “… the Department of Health and Human Services’ Office of Inspector General notified Dallas-based Tenet that it intended to exclude Alvarado Hospital Medical Center in San [...]
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The “Stark” statute, 42 U.S.C. §1395nn, is also known as the Physician Self-Referral Law or Section 1877 of the Social Security Act. The Stark law was intended to prevent physicians from profiting (actually or potentially) from their own referrals. The Stark statute acts prospectively, i.e., it prohibits relationships that have been demonstrated to encourage over-utilization. [...]
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