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:

whistleblowers

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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President Denounces Health Care Fraud Yesterday

by Nolan and Auerbach on March 11, 2010

During a March 10, 2010 rally in St. Charles, Mo., President Obama blamed health care fraud, waste and abuse for costing taxpayers almost $100 billion in 2009, according to an Associated Press story published that day on Yahoo News. He said such payments, which include Medicare fraud and Medicaid fraud, amounted to more than is [...]

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Teaching Hospital Settles Physician Billing Case

by Nolan and Auerbach on July 16, 2009

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 [...]

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Physicians Snared By Growing Medicare Fraud Strike Team

by admin on July 15, 2009

Marcella Auerbach was quoted by Amy Lynn Sorrel in her article “Physicians snared by growing Medicare fraud strike team,” which appeared in the July 6 online edition of American Medical News. The article discussed the announcement by the Department of Justice and Health & Human Services that criminal charges were filed against 53 doctors and [...]

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Calif. County to Pay U.S. $6.8 Million for Allegations of False Medicare, Medicaid Claims

by Nolan and Auerbach on March 18, 2009

The U.S. Department of Justice announced March 12, 2009, that San Mateo County, Calif., will pay the United States $6.8 million to resolve allegations that the San Mateo Medical Center (SMMC) submitted false claims to the United States in connection with payments from the Medicare and Medicaid programs. The government alleges that SMMC engaged in [...]

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Whistleblower Lawsuit Against New Jersey Hospital Results in $3.85 Million Payment for Medicare Fraud

by Nolan and Auerbach on November 4, 2008

Cooper University Hospital in New Jersey has agreed to pay $3.8 million to the federal government as the result of inflating its Medicare claims from 2001 to 2003.  Specifically the Department of Justice alleged that the hospital improperly increased its charges for inpatient and outpatient care to make it appear that the charges were greater [...]

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Scooter Store Gets Caught Scooting Medicare

by Nolan and Auerbach on May 25, 2007

In order to settle allegations that the Scooter Store submitted false claims to Medicare, the New Braunfels, Texas company agreed to pay the federal government $4 million and forego another $13 million in Medicare payments. The payments resolve several lawsuits including a whistleblower complaint from a former Scooter Store employee.  The whistleblower will receive $3.2 [...]

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Home Health Care Industry Riddled With Fraud

by Nolan and Auerbach on October 30, 2006

Marietta Diaz, a former employee of Provident Health Care filed a whistleblower lawsuit against her former employer. Diaz claimed that Provident Home Health Care Services, Inc. and Tri-Regional Home Health Care Inc. billed Medicare for home health services that were never provided. Los Angeles Assistant U.S. Attorney Consuelo Woodhead said that this case is not [...]

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