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.

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 than they actually were.  The whistleblower litigation was brought by Anthony Kite, an independent hospital consultant.

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.

Leave a Comment