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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U.S. Food and Drug Administration

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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$50 Million Medicare Fraud Surrounds Clinics, Pharmacies and Durable Medical Equipment Companies

by Nolan and Auerbach on April 9, 2007

The owner of three Miami, Florida medical equipment companies was convicted by a jury of Medicare fraud with sentencing scheduled for June 12th.  This prosecution was part of a greater scheme which included kickbacks involving 23 clinics, 3 pharmacies and 3 durable medical equipment companies.  According to R. Alexander Acosta, U.S. Attorney for the Southern [...]

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Guess What Else is NOT a Top Priority of the FDA?

by Nolan and Auerbach on July 12, 2006

Answer: Monitoring postmarketing study commitments. The FDA lacks an effective system for monitoring postmarketing study commitments.  See the latest OIG Report, dated June 2006.

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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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