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:

Whistleblower Law

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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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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How to be a Successful Whistleblower Under the False Claims Act and Still Have Money for Lunch

by Nolan and Auerbach on December 28, 2006

A corporate insider is in a unique position to know the details about how their employer has cheated the United States Government. Nothing beats the knowledge an insider can impart. Whistleblowers are the real heroes in the fight against fraud. The person (plaintiff) who brings an action under the False Claims Act is called a [...]

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Health Care Employers Required to Educate Employees on False Claims Act Whistleblowing

by Nolan and Auerbach on August 30, 2006

Employee Section 6032 “Employee Education About False Claims Recovery” requires that entities receiving or making more than $5 million in annual payments under a state Medicaid plan, must,  as a condition of participation, create written compliance policies designed to educate employees, contractors and agents about false claims, false statements and whistleblower protections under applicable federal [...]

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False Certification Case Settled for $9 million

by Nolan and Auerbach on August 10, 2006

This case settlement is a recent example of false claims act liability based upon false certification. Although this is not a healthcare fraud case, we point out that false certification in the healthcare fraud field is still probably going strong and the basis for liability. To see a brief story, click here.

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Qui Tam Lawsuits Stike Hard at Healthcare Fraud

by Nolan and Auerbach on August 3, 2006

A new Taxpayers Against Fraud Report confirms the success of the Qui Tam provisions of the False Claims Act in fighting health care fraud. To see the full Report, click here.

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