For the full press release, go to: http://www.justice.gov/opa/pr/2010/March/10-civ-240.html. For more information about qui tam law and Medicare fraud, contact Nolan and Auerbach, PA.

President Obama’s speech further confirms that the fight against healthcare fraud is a top priority for the government, and its recently heightened efforts to recoup healthcare dollars by prosecuting violators underscores that message. Simply put, in order to afford a viable healthcare system unnecessary spending must be eliminated. We’ve said it before – the government is keeping a watchful eye on Medicare and Medicaid fraud, as well as fraud within the pharmaceutical industry. In fact, just last week the Office of Inspector General announced Medicaid Fraud Control Units recovered $1.3 billion in 2008.

Needing all the help they can get, federal regulators see whistleblowers as crucial players in the fight against healthcare fraud. As Marcella Auerbach pointed out in an interview with PBS in July, the healthcare industry receives a $15 return for every dollar the government spends on efforts to fight fraud. By spotting fraud early on, significant money can be recovered for patients and taxpayers.

For the entire transcript of President Obama’s speech, go to:
http://www.whitehouse.gov/the_press_office/Remarks-by-the-President-to-a-Joint-Session-of-Congress-on-Health-Care/

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

In celebration of the 44th anniversary of Medicare, the segment reported that a multi-state crackdown on Medicare fraud resulted in 32 arrests in Houston, Boston, and Miami, recovering approximately $370 million.

Marcella was quoted on the financial benefits of fraud investigations, suggesting that costs for health care reform – a topic of current heated controversy – could be significantly defrayed by recovering more money from Medicare fraud and similar healthcare violations.

Marcella pointed out that, with the Federal government’s strengthened efforts to fight Medicare fraud in particular, the system has received a $15 return for every dollar spent on investigations and prosecution.

To view the full segment, go here: http://www.pbs.org/nbr/info/local-player.html?s=nbre07s2dccq669

To read the related article, go here: http://www.pbs.org/nbr/blog/2009/07/fighting_medicare_fraud.html

The settlement was the second time UMDNJ paid the government for the double-billing scheme. The first was in 2005 when the hospital paid $4.9 million to the state of New Jersey to settle criminal charges.

In the end, UMDNJ ended up paying nearly $7 million total for the scheme, but, according to Marcella Auerbach, managing partner at Nolan & Auerbach, the hospital could have avoided the lengthy and costly litigation and saved millions, if it had acted differently.

According to Auerbach, a former federal prosecutor who now exclusively represents whistleblowers in healthcare fraud cases, UMDNJ’s in-house attorney discovered the hospital and its physicians were billing for the same services back in 2001-before any whistle was blown. The lawyer brought the issue to the hospital’s attention, but the management looked the other way, and continued to double-bill for the three years following the warning, he says.

The fact that UMDNJ knew about the double-billing, knew it was illegal, and continued to do it, is what makes the case so interesting. According to Auerbach, the hospital could have saved millions if it ceased double-billing and came clean to the government through a self-disclosure.

“It’s a bet,” Auerbach says. “They are betting on the fact they won’t get caught.”

However, UMDNJ hit one too many times and ended up going bust. The man who busted the hospital is Steven Simring, MD, who will collect $801,000 for his efforts.

Based on the details of the case, Auerbach was not surprised to see a doctor blow the whistle on the hospital. Evidence shows that there were many discussions about the double-billing in which doctors expressed concern. Auerbach says it comes as no surprise that Simring would come forward and blow the whistle rather than risk being prosecuted himself.

Auerbach, who has extensive experience in whistleblower cases, says the gambler’s mind-set is common in whistleblower cases. Rather than play by the rules and fess up, many facilities try to sweep problems under the rug and pretend they never happened. Some even go one step further. Auerbach says many times concerned employees will raise a compliance concern only to be handed a pink slip for their trouble, which raises another legal problem.

“These people are fired for bringing points up,” Auerbach says, “Then they come to us and they have two claims.”

Auerbach says this case can be seen as a message to healthcare leaders. The DOJ is saying take any compliance concerns presented by employees or legal council very seriously and, when appropriate, self-disclose. The alternative is a lengthy, expensive, public whistleblower case.

For the entire article, go to: http://www.healthleadersmedia.com/content/234437/topic/WS_HLM2_FIN/Doublebilling-Settlement-Highlights-Whistleblower-Concerns.html

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

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.

The False Claims Act enables people to expose fraud and was originally enacted in 1863 for that very purpose. In general, the False Claims Act covers fraud involving any federally funded contract or program, with the exception of income tax fraud. The healthcare and defense industry have traditionally been the top two areas involving prosecution under the False Claims Act.

The word alone of a whistleblower is simply not enough. A whistleblower needs to organize and collect evidence of the fraud so there is a sound basis of proof to support the allegations.

The types of allegations for which a corporate insider needs evidence under the False Claims Act include corporate involvement on the following:

1. Knowingly submitting (or causing the submission of) false or fraudulent claims for payment by the Federal Government.

2. Knowingly making (or causing to be made) a false record or statement to get a false or fraudulent claim paid or approved by the Federal Government.

3. Knowingly making (or causing to be made) a false record or statement to conceal, avoid, or decrease an obligation to pay or transmit property to the Federal Government.

The False Claims Act is intended to reach all fraudulent activity which causes the government to pay out too much money. Some common forms are claims for goods or services not provided, or provided in violation of contract terms, specification, statute, or regulation (such as in conjunction with kickbacks). Each and every claim submitted under a contract or other agreement which was originally obtained by means of false statements, falsities, or in knowing violation of any statute or applicable regulation, constitutes a false claim.

KEEP QUIET AND SHARE YOUR CONCERNS WITH NO ONE until you have spoken with an attorney who specializes in the False Claims Act. Many before you have spoken up only to have become summarily “let go” or demoted. Speak up and you might not have money for lunch at the end of the day.

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The fraudulent activity continues in spite of a $2.2 million settlement paid to a whistleblower in December 2005, who claimed he was fired for objecting to this scheme. The University signed a settlement agreement with the after it was charged with Medicaid fraud involving the double-billing of nearly $5 million worth of procedures.

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To read more click here.