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 Whistleblower Effect: How Qui Tam Actions Are Changing the Deterrence Calculus for Hospice Providers

by Nolan and Auerbach on January 27, 2012

Diakon Hospice, one of the oldest hospices in Pennsylvania, recently paid nearly $11 million to the Federal Government, related to submitting Medicare claims for beneficiaries who were not eligible for hospice benefits under the Medicare regulations. Diakon had voluntarily disclosed the problem to the Government. By voluntarily stepping forward, Diakon may have avoided a government lawsuit under the False Claims Act.

Hospice care, which offers emotional, physical, and spiritual care in addition to end-of-life palliative care to terminally ill patients, is covered under Medicare Part A, under very specific conditions. False Claims Act violations arise when hospices violate these conditions and purposefully submit ineligible claims for reimbursement. For example, a hospice provider potentially runs afoul of the FCA when it submits claims for services that are ineligible for reimbursement, misrepresents the conditions of patients, or misrepresents the purpose of hospice services to patients and their families in order to maintain their admission status for hospice care.

For more information about qui tam law and Medicare fraud, contact Nolan and Auerbach, P.A.

 

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