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.

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Qui tam

Hospitals in Seven States to Pay more than $9.4 Million for Unnecessary Inpatient Kyphoplasties

by Nolan and Auerbach on May 18, 2010

Nine hospitals in seven states will pay the U.S. more than $9.4 Million to settle allegations that the health care facilities submitted false claims to Medicare, the U.S. Department of Justice announced May 17, 2010. The hospitals are alleged to have overcharged Medicare between 2000 and 2008 when performing kyphoplasty, a minimally-invasive procedure used to [...]

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President Denounces Health Care Fraud Yesterday

by Nolan and Auerbach on March 11, 2010

During a March 10, 2010 rally in St. Charles, Mo., President Obama blamed health care fraud, waste and abuse for costing taxpayers almost $100 billion in 2009, according to an Associated Press story published that day on Yahoo News. He said such payments, which include Medicare fraud and Medicaid fraud, amounted to more than is [...]

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Texas Hospital to Pay U.S. Nearly $1 Million for Allegations it Violated the False Claims Act

by Nolan and Auerbach on January 7, 2010

Arlington Memorial Hospital, Arlington, Texas, has agreed to pay the U.S. $990,509.50 to resolve allegations that it violated the civil False Claims Act, according to a Jan. 4, 2010 announcement by U.S. Attorney James T. Jacks of the Northern District of Texas. The Texas hospital allegedly violated the civil False Claims Act by submitting improper [...]

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Grassley Introduces Bill to Fight Medicare Fraud

by Nolan and Auerbach on November 16, 2009

Working to protect taxpayers and Medicare beneficiaries, U.S. Senator Chuck Grassley has introduced legislation to give the federal government more time to pay Medicare providers when waste, fraud and abuse is suspected, according to a November 16, 2009 press release on IowaPolitics.com. Right now, federal law requires that Medicare send payment within a very short [...]

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Teaching Hospital Settles Physician Billing Case

by Nolan and Auerbach on July 16, 2009

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 [...]

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Miamians Charged in Elaborate Medicare Fraud

by Nolan and Auerbach on June 24, 2009

Federal prosecutors charged eight conspirators in Miami with defrauding the U.S. healthcare system by creating phony clinics that churned out $100 million of medical bills in five states, according to a June 23, 2009 Reuters news article. The sophisticated scheme involved fake clinics, which in reality were empty storefronts or post office boxes–none providing any [...]

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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 [...]

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