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:

Medicare

Alleged False Claims Act Violations Land Minnesota Hospitals in Hot Water

by Nolan and Auerbach on May 22, 2009

Three HealthEast Care System hospitals have agreed to pay the United States $2.28 million to settle allegations that the health care facilities submitted false claims to Medicare, the U.S. Justice Department announced May 21, 2009. According to the DOJ press release, the settlement resolves allegations that the St. Paul, Minn.-based hospitals overcharged Medicare from 2002 [...]

{ 0 comments }

Homecare Association Presents 13-point Plan to Eliminate Medicare Waste, Fraud and Abuse

by Nolan and Auerbach on May 7, 2009

In April 2009, the American Association for Homecare presented Congress with its 13-point legislative action plan, called the Medicare Anti-Fraud Legislative Plan, aimed at eliminating waste, fraud and abuse in Medicare’s home medical equipment sector. The plan’s steps, according to the homecare association, would eliminate most of the Medicare fraud attributed to the home medical [...]

{ 0 comments }

Houston Hospital to Pay U.S. More Than $9 Million for Alleged Medicare Fraud

by Nolan and Auerbach on March 27, 2009

Methodist Hospital in Houston has agreed to pay the United States $9.99 million to settle allegations that it defrauded the federal Medicare program, the U.S. Department of Justice announced March 26, 2009. The government alleged that, between January 2001 and August 2003, Methodist improperly inflated charges for inpatient and outpatient care to make its costs [...]

{ 0 comments }

$10 million Medicare fraud scheme involves Miami HIV Infusion Clinics

by Nolan and Auerbach on March 23, 2009

Four Miami-area physicians and medical assistants pleaded guilty March 23, 2009 to a $10 million Medicare fraud scheme involving HIV infusion clinics, according to a Department of Justice (DOJ) press release.  The four defendants worked at Midway Medical Center Inc.  a Miami clinic that purported to specialize in the treatment of HIV patients. One of [...]

{ 0 comments }

Calif. County to Pay U.S. $6.8 Million for Allegations of False Medicare, Medicaid Claims

by Nolan and Auerbach on March 18, 2009

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 [...]

{ 0 comments }

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 [...]

{ 0 comments }

Oops! CMS Paid Millions to Medicare Advantage Plans after Enrollees Died

by Nolan and Auerbach on March 11, 2009

The Centers for Medicare and Medicaid Services (CMS) paid about $4.4 million to Medicare Advantage plans on behalf of enrollees, after those enrollees had died. CMS made the improper payments for 2,657 deceased enrollees between January 2003 and April 2007, according to the March 2009 report “Review of Medicare Payments to Managed Care Plans on [...]

{ 0 comments }

New York Hospital Agrees to Settle Qui Tam

by Nolan and Auerbach on March 6, 2009

The Government announced today that a former employee  of Victory Memorial Hospital’s qui tam lawsuit has resulted in a settlement with the United States of at least $2.3 million to resolve claims that the hospital defrauded the Medicare program. The Medicare Fraud settlement covers allegations that Victory Memorial submitted Cost Reports for 1996 and 1997 [...]

{ 0 comments }

President’s Proposed 2010 Budget Aims to Increase Revenue by Reducing Fraud, Abuse

by Nolan and Auerbach on March 5, 2009

President Obama’s fiscal year 2010 proposed budget estimates that reducing health care fraud, waste and abuse could save the government about $5 billion in a decade’s time. The budget pledges nearly $1.5 billion for its Health Care Fraud and Abuse Control Program (HCFAC), including a $311 million increase in HCFAC funding. The budget takes aim [...]

{ 0 comments }

Two Chicago Cardiologists Charged With Medicare Fraud

by Nolan and Auerbach on February 10, 2009

Chicago, Illinois—  Cardiologist Sughil Sheth received $13.4 million over a period of five years (2002-2007) by billing Medicare for reimbursement of extensive cardiac care that was not, according to U.S. Attorney Patrick Fitzgerald, ever performed.  Sheth allegedly performed Medicare Fraud by hiring individuals to falsify patient names, insurance data, and dates in order to bill [...]

{ 0 comments }

← Previous Entries

Next Entries →