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:

qui tam lawsuit

Robert Wood Johnson University Hospital to Pay $6.35 Million to Resolve Medicare Fraud Allegations

by Nolan and Auerbach on March 22, 2010

Robert Wood Johnson University Hospital Hamilton, a New Jersey-based hospital, has agreed to pay $6.35 million to settle allegations that the hospital defrauded Medicare, the United States Department of Justice (DOJ) announced March 19, 2010. Two lawsuits filed against the Hamilton, N.J., facility alleged that the hospital fraudulently inflated its charges to Medicare patients to [...]

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Double-billing Settlement Highlights Whistleblower Concerns

by Nolan and Auerbach on June 23, 2009

Earlier this week, the University of Medicine and Dentistry of New Jersey agreed to pay the federal government $2 million to settle a whistleblower lawsuit alleging that it bilked Medicaid in a double-billing scheme that started in 1993 and ended in 2003, according to the Department of Justice. The settlement was the second time UMDNJ [...]

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UMDNJ to Pay U.S. $2 Million for Allegations of Medicare Fraud

by Nolan and Auerbach on June 9, 2009

The University of Medicine and Dentistry of New Jersey (UMDNJ) has agreed to pay the United States $2 million to resolve federal civil fraud allegations that its hospital defrauded Medicaid, the Justice Department announced June 9, 2009, according to a press release on PR Newswire. From 1993 to 2004, UMDNJ’s University Hospital submitted claims to [...]

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$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 [...]

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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 [...]

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