Medicare Fraud 101 » United States Department of Justice

Teaching Hospital Settles Physician Billing Case

Nolan and Auerbach — Thu, 16 Jul 2009 19:11:03 +0000

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 on behalf of physicians who were not present when residents performed the procedures.

LSUHSC-S agreed to pay more than $700,000 to resolve the False Claims Act allegations. The complaint was initiated by two employees-turned-whistleblowers who both plan to file another suit to collect lost wages, benefits, and damages for their damaged reputations.

Ken was quoted on the connection between this settlement and Physicians at Teaching Hospitals (PATH), the Department of Justice (DOJ) and Office of Inspector General’s (OIG) national enforcement project in the area of teaching physicians. While the goal of PATH was to target major offenders, Ken does not find it surprising that smaller offenders like LSUHSC-S are showing up with independent whistleblower cases. This is one of the several beneficial scenarios to taxpayers that the qui tam law was intended to capture. Ken also highlighted that many settlements are now originated with whistleblowers, instead of the DOJ or OIG like with PATH.

Inspector general addresses health care fraud

Nolan and Auerbach — Fri, 26 Jun 2009 15:17:32 +0000

On Thursday, June 25, 2009, Daniel R. Levinson presented testimony on the Office of the Inspector General’s (OIG’s) role in addressing health care waste, fraud and abuse, as well as its plans for health care reform.

Talking before the Subcommittee on Health of the House Energy and Commerce Committee Levinson, inspector general of the U.S. Department of Health and Human Services (HHS), said these recommendations were based on OIG’s evaluations, investigations and audits on issues, such as fraudulent activity by health care providers; excessive payments for medical services, equipment, and prescription drugs; and financial conflicts of interests within the institutions charged with protecting the health of the American public.

He emphasized that collaboration and innovation are essential in the fight against fraud. Levinson cited the launch of Health Care Fraud Prevention and Enforcement Action Team (HEAT), a joint task force consisting of OIG and Department of Justice senior leadership.

The inspector general identified health care vulnerabilities to fraud and waste and outlined OIG’s program to strengthen the integrity of government-run health care, called the Five-Principle Strategy to Combat Health Care Fraud, Waste, and Abuse.

For the full testimony, go to: http://www.oig.hhs.gov/testimony/docs/2009/06252009_testimony_health_reform.pdf.

For more information about qui tam law and health care fraud, contact Nolan and Auerbach, PA. http://www.whistleblowerfirm.com/.

Alleged False Claims Act Violations Land Minnesota Hospitals in Hot Water

Nolan and Auerbach — Fri, 22 May 2009 17:06:53 +0000

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 to 2007 by thousands of dollars each time they performed kyphoplasty, a minimally-invasive procedure used to treat certain spinal fractures that often are due to osteoporosis. The procedure can be performed safely as an outpatient surgery, but the government contends that the HealthEast hospitals performed the procedure on an inpatient basis in order to increase their Medicare billings.

The settlement with HealthEast follows the government’s May 2008 settlement with Medtronic Spine LLC, corporate successor to Kyphon Inc. Medtronic Spine paid $75 million to settle allegations that the company defrauded Medicare by counseling hospital providers to perform kyphoplasty procedures as an inpatient procedure.

The qui tam or whistleblower lawsuit against the HealthEast hospitals was brought under the False Claims Act.

To read the full press release, go to: http://www.usdoj.gov/opa/pr/2009/May/09-civ-497.html.

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

$10 million Medicare fraud scheme involves Miami HIV Infusion Clinics

Nolan and Auerbach — Mon, 23 Mar 2009 15:21:55 +0000

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 the accused physicians admitted to similar conduct at five other Miami area HIV-infusion clinics.

One of the defendants, a physician who co-owns the Midway clinic and practiced at the others, admitted he and his co-conspirators billed the Medicare program for HIV injection and infusion services that he knew were medically unnecessary and, in some instances, never actually were provided. The accused admitted to causing more than $20 million in false claims to be submitted to the Medicare program.

To see the entire press release, go to http://www.usdoj.gov/opa/pr/2009/March/09-crm-261.html. For more about qui tam law and Healthcare Fraud, contact Nolan and Auerbach, PA.

CMS Steps Up Efforts to Ferret Out Fraud -Southern Florida is mentioned

Nolan and Auerbach — Tue, 24 Oct 2006 22:26:11 +0000

CMS recently announced multiple accomplishments and projects, all designed to reduce fraud and abuse: the Los Angeles office of CMS revoked the billing numbers of 117 providers who had presented false claims or suspicious business operations, saving $200 million, editing the system to stop payment on claims using billing numbers from deceased providers saved another $4 million, and targeted efforts against independent diagnostic testing facilities resulted in revocation of the billing privileges of 83 IDTFs and denied $445 million in claims for “beneficiary sharing.”

CMS also announced that it had expanded its satellite offices in Miami and Los Angeles, “providing additional on-the-ground efforts to identify and report fraud, waste and abuse in Medicare.” In addition, activity in the Miami office has included a cooperative federal/state task force on abuses by independent diagnostic facilities investigating complaints and using site visits, record reviews, administrative actions and data analysis. CMS announced that it and the Florida agencies have referred 400 criminal investigations to law enforcement authorities, revoked the licenses and billing privileges of clinics and practitioners, and added edits to the claims system to “auto deny” claims for medically unbelievable services and flag high-volume claims for particular services. CMS further announced that the U.S. Department of Justice has begun 63 criminal cases and 38 civil cases involving Medicare fraud since October 2005.

For more information click here.