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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United States

Inspector general addresses health care fraud

by Nolan and Auerbach on June 26, 2009

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. [...]

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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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Sheehan Calls for Aggressive Actions against Medicare, Medicaid Fraud and Abuse

by Nolan and Auerbach on April 23, 2009

On April 22, 2009,  New York Medicaid Inspector General James Sheehan testified before the U.S. Senate Committee on Homeland Security and Governmental Affairs Subcommittee on Medicare and Medicaid about waste and fraud. New York was the most successful state in the nation in Medicaid program integrity in the past year, measured by fraud and abuse [...]

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Government Cracks Down on Violators as Medicare Fraud Increases

by Nolan and Auerbach on January 10, 2008

The federal government is about to announce a national effort to fight Medicare fraud by looking at billing by medical equipment suppliers. There has been an increase in Medicare fraud, particularly in Southern California and South Florida where Medicare are plenty. The crackdown is a nationwide effort by the U.S. Department of Health and Human [...]

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The Decline in FDA Enforcement Activity

by Nolan and Auerbach on June 4, 2007

Congressman Waxman’s United States House of Representatives Committee on Government Reform issued a report entitled “Prescription for Harm/The Decline in FDA Enforcement Activity” in June 2006. Enforcement is down and our FDA-related filings are up.  Any relationship?

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Has Greed Driven Stent Implantation?

by Nolan and Auerbach on May 17, 2007

The FBI is apparently investigating allegations that a Maryland cardiologist, Dr. John “Jack” McLean was performing unnecessary stent implantations on his patients.  Officials have stated that most of the patients involved are Medicare patients.  On average, Medicare pays between $11,184 to $14,287 for a drug-eluting stent procedure. The investigation which involves the FBI as well [...]

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

by Nolan and Auerbach on October 24, 2006

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 [...]

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South Carolina Medical Center to Pay $3.75 Million Fine

by Nolan and Auerbach on August 23, 2006

As a result of violating Stark Laws and submitting improper bills to Medicare, Medicaid and TRICARE, the Marion County Medical Center in South Carolina will pay $3.75 Million arising out of a qui tam False Claims Act case filed by a whistleblower. For more information click here.

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Are Clinical Drug Studies Being Manipulated?

by Nolan and Auerbach on April 28, 2006

A pharmaceutical company can violate the false claims act by submitting false statements in connection with drug applications and other records to the United States Food and Drug Administration (”FDA”).  For example, clinical trial results can involve false statements; and subsequent false statements and claims in marketing materials promoted to the medical community and other [...]

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