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.

The Beat Goes On…Fraud Continues at the University of Medicine and Dentistry of New Jersey

by Nolan and Auerbach on November 21, 2006

A federal monitor’s report found that the University of Medicine and Dentistry of New Jersey made since 2002, $5.7 million in illegal payments to physicians in exchange for their heart patient referrals. As the result of these patient referrals, physicians were given “no-show” teaching jobs in excess of $150,000 per year. The monitoring system was put in place as the result of oversight put in place by the University to avoid prosecution on multi-million dollar fraud charges. This fraudulent scheme could cost the University as much as $84.5 million for these illegal referrals.

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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