The hospitals are alleged to have overcharged Medicare between 2000 and 2008 when performing kyphoplasty, a minimally-invasive procedure used to treat certain spinal fractures. The hospitals performed the procedure on an in-patient, rather than less expensive outpatient basis, in order to increase their Medicare billings.

The settling facilities and the amount being paid by each to the United States are Ball Memorial Hospital, Muncie, Ind. ($1,995,431); Bethesda Memorial Hospital, Boynton Beach, Fla. ($356,079); Bloomington Hospital, Bloomington, Ind. ($1,443,848); Genesys Regional Medical Center, Grand Blanc, Mich. ($931,742); Huntsville Hospital, dba The Health Care Authority of the City of Huntsville, Huntsville, Ala. ($1,992,756); Palmetto Health dba Palmetto Health Baptist Hospital, Columbia, S.C. ($1,861,083.14); St. Elizabeth Medical Center, Utica, N.Y. ($195,976); St. Mary’s of Michigan Hospital, Saginaw, Mich. ($260,065.21); and United Hospital, St. Paul, Minn. ($428,656).

The government settled Medicare fraud cases in 2009 with nine other hospitals for kyphoplasty-related claims, as well as settled for $75 million in 2008 with Medtronic Spine LLC, corporate successor to Kyphon Inc., for causing the Kyphoplasty – related claims. Whistleblowers, or qui tam relators, helped to expose the alleged wrongdoing.

For the full release click here.  For more information about qui tam law and Medicare fraud, contact Nolan and Auerbach, PA.

He said such payments, which include Medicare fraud and Medicaid fraud, amounted to more than is spent on the Education Department and the Small Business Administration combined, according to the article.

Obama’s anti-fraud approach includes hiring private auditing firms, called Recovery Audit Contractors, or RACs, to comb health care businesses—including doctors’ practices—for health care fraud and abuse. The auditors, like whistleblowers or qui tam relators, would keep part of what they help to recover.

The White House said a Medicare pilot program, using such auditors, recouped $900 million for taxpayers from 2005-08, according to AP. We think the RAC’s provide a huge savings to taxpayers at minimum just because of the deterrent effect alone. It is our understanding that health systems are generally aware of upcoming audits and their scope. The recoveries they have centered on medical necessity of inpatient admissions, an area we believe will be an upcoming focus of the OIG.

Click here here for the full story.  For more information about qui tam law and Medicare  fraud, contact Nolan and Auerbach, PA.

LSUHSC-S agreed to pay more than $700,000 to resolve the False Claims Act allegations. The complaint was initiated by two employees-turned-whistleblowers who both plan to file another suit to collect lost wages, benefits, and damages for their damaged reputations.

Ken was quoted on the connection between this settlement and Physicians at Teaching Hospitals (PATH), the Department of Justice (DOJ) and Office of Inspector General’s (OIG) national enforcement project in the area of teaching physicians. While the goal of PATH was to target major offenders, Ken does not find it surprising that smaller offenders like LSUHSC-S are showing up with independent whistleblower cases. This is one of the several beneficial scenarios to taxpayers that the qui tam law was intended to capture. Ken also highlighted that many settlements are now originated with whistleblowers, instead of the DOJ or OIG like with PATH.

These indictments come immediately after the government recently publicized the creation of a Medicare anti-fraud task force aimed at reducing the millions of dollars wasted every year in healthcare fraud. The task force has said it will focus on all participants in fraud, be it the corporation, the physician, or even patients.  

Marcella pointed out that she believed there will be many more similar Medicare fraud indictments and cases in the near future. Meanwhile, whistleblowers will continue to play an important and crucial role in the government’s crackdown on healthcare fraud. When employees or physicians who are aware of misconduct do not come forward, the government will initiate investigations proactively, often resulting in a large number of indictments against the company or hospital, as demonstrated by this bellwether case in Detroit.

The government alleges that SMMC engaged in Medicare Fraud by falsely inflated its bed count to Medicare in order to receive higher payments under Medicare’s Disproportionate Share Hospital (DSH) adjustment. The government also alleges that San Mateo County improperly obtained federal payments under the Medicaid program for services provided to patients at Institutes of Mental Disease (IMDs) who were between the ages of 22 and 64. This is once again an example of a case where the simple manipulation of a few numerals results in overpayments of millions of dollars. The lawsuit was filed under the qui tam or whistleblower provisions of the False Claims Act by a former employee of San Mateo County.

For a copy of the full press release, http://www.usdoj.gov/opa/pr/2009/March/09-civ-224.html. For more information about qui tam whistleblower law, contact Nolan and Auerbach, PA.

This outlier fraud case involved supplemental payments Medicare makes when a patient exceeds a predetermined payment amount, also known as outlier payments.  Similar lawsuits have been brought against other New Jersey hospitals with equal success as the result of their engaging in Medicare fraud.

To learn more click here or if you have False Claims Act case contact Nolan & Auerbach P.A.

To read more click on this story click here and also see Nolan Law Firm for more information about whistleblowers and medicare fraud.

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