The GAO strategies should be implemented by the Department of Health and Human Services and its components, the OIG and CMS. The strategies are intended to ward off fraud before it happens, something which will benefit taxpayers in the long run. Medicare and Medicaid has too long been a pay and chase reimbursement system.

For the GAO Report or information about qui tam law and Medicare fraud, contact Nolan and Auerbach, PA.

The hospitals are alleged to have overcharged Medicare between 2000 and 2008 when performing kyphoplasty, a minimally-invasive procedure used to treat certain spinal fractures. The hospitals performed the procedure on an in-patient, rather than less expensive outpatient basis, in order to increase their Medicare billings.

The settling facilities and the amount being paid by each to the United States are Ball Memorial Hospital, Muncie, Ind. ($1,995,431); Bethesda Memorial Hospital, Boynton Beach, Fla. ($356,079); Bloomington Hospital, Bloomington, Ind. ($1,443,848); Genesys Regional Medical Center, Grand Blanc, Mich. ($931,742); Huntsville Hospital, dba The Health Care Authority of the City of Huntsville, Huntsville, Ala. ($1,992,756); Palmetto Health dba Palmetto Health Baptist Hospital, Columbia, S.C. ($1,861,083.14); St. Elizabeth Medical Center, Utica, N.Y. ($195,976); St. Mary’s of Michigan Hospital, Saginaw, Mich. ($260,065.21); and United Hospital, St. Paul, Minn. ($428,656).

The government settled Medicare fraud cases in 2009 with nine other hospitals for kyphoplasty-related claims, as well as settled for $75 million in 2008 with Medtronic Spine LLC, corporate successor to Kyphon Inc., for causing the Kyphoplasty – related claims. Whistleblowers, or qui tam relators, helped to expose the alleged wrongdoing.

For the full release click here.  For more information about qui tam law and Medicare fraud, contact Nolan and Auerbach, PA.

For more information about qui tam law and Medicare fraud, contact Nolan and Auerbach, PA.

Additional Reference Links:

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For the full press release, go to: http://www.justice.gov/opa/pr/2010/March/10-civ-240.html. For more information about qui tam law and Medicare fraud, contact Nolan and Auerbach, PA.

The two lawsuits were brought under the qui tam, or whistleblower, provisions of the False Claims Act. They alleged that the hospital inflated its charges to obtain supplemental outlier payments for cases that were not extraordinarily costly and for which outlier payments should not have been paid, according to the DOJ.

For the full release click here.  For more information about qui tam law and Medicare fraud, contact Nolan and Auerbach, PA.

He said such payments, which include Medicare fraud and Medicaid fraud, amounted to more than is spent on the Education Department and the Small Business Administration combined, according to the article.

Obama’s anti-fraud approach includes hiring private auditing firms, called Recovery Audit Contractors, or RACs, to comb health care businesses—including doctors’ practices—for health care fraud and abuse. The auditors, like whistleblowers or qui tam relators, would keep part of what they help to recover.

The White House said a Medicare pilot program, using such auditors, recouped $900 million for taxpayers from 2005-08, according to AP. We think the RAC’s provide a huge savings to taxpayers at minimum just because of the deterrent effect alone. It is our understanding that health systems are generally aware of upcoming audits and their scope. The recoveries they have centered on medical necessity of inpatient admissions, an area we believe will be an upcoming focus of the OIG.

Click here here for the full story.  For more information about qui tam law and Medicare  fraud, contact Nolan and Auerbach, PA.

The United States alleged that FORBA was liable for causing the submission of claims for reimbursement for a wide range of dental services provided to low-income children that were either medically unnecessary or performed in a manner that failed to meet professionally-recognized standards of care. These services included performing pulpotomies (baby root canals), placing crowns, administering anesthesia (including nitrous oxide), performing extractions, and providing fillings and/or sealants.

For the full release, go to: http://www.justice.gov/opa/pr/2010/January/10-civ-052.html.

For more information about qui tam law and health care fraud, contact Nolan and Auerbach, PA.

On the same day of the release, the Department of Justice and U.S. Department of Health and Human Services announced the expansion of Strike Force operations into Brooklyn, Tampa, and Baton Rouge.  Strike Force teams are operating in seven cities: Miami, Los Angeles, Detroit, Houston, Brooklyn, Tampa, and Baton Rouge.

The Strike Force has obtained indictments of more than 460 individuals and organizations that collectively have falsely billed the Medicare program for more than one billion dollars, according to the release.

For the full release, go to: http://www.fbi.gov/pressrel/pressrel09/medicare_121509.htm.

For more information about qui tam law and health care fraud, contact Nolan and Auerbach, PA.

The Texas hospital allegedly violated the civil False Claims Act by submitting improper claims for payment to the Medicare program between July 1, 2003, and July 1, 2007, for pulmonology-related items and services.

In August 2007, Arlington Memorial’s corporate parent self-disclosed to the Office of Inspector General for the Department of Health and Human Services (OIG) that a long-standing contract with a physician group for the interpretation of arterial blood gas (ABG) tests potentially violated federal law. The U.S. contends that Arlington Memorial Hospital knowingly failed, through the actions of its former president, to eliminate payments to the group for the interpretations of hospital tests that were not performed, and that Arlington Memorial Hospital AMH knew such payments were not in compliance with federal legal requirements, according to the U.S. Department of Justice press release.

For the full release, go to: http://www.justice.gov/usao/txn/PressRel10/arlington_memorial_hospital_settle_pr.html.

For more information about qui tam law and health care fraud, contact Nolan and Auerbach, PA.

Right now, federal law requires that Medicare send payment within a very short time frame, even when there is risk of fraud, waste or abuse.

The bill Grassley introduced on November 16 – the Fighting Medicare Payment Fraud Act of 2009 – would give the Secretary of Health and Human Services authority to extend the time period in which payments must be made under the prompt payment rule if the Secretary determines there is a likelihood of fraud, waste or abuse. With this additional time, the Secretary would be required to conduct more detailed reviews of the claims in question to make sure they are supposed to be paid.

The Grassley bill also requires the experts in the Office of Inspector General to recommend, on at least an annual basis, categories of providers or suppliers where additional scrutiny is needed before payments are made under the prompt payment rule. To make sure there is action on these recommendations, the Secretary would be required to provide a response to the Inspector General on these recommendations, according to the release.

For the full press release, go to: http://www.iowapolitics.com/index.iml?Article=177068.

For information about qui tam law and health care fraud, contact Nolan and Auerbach, PA.