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Medicare Fraud 101

Medicare Fraud News, Breaking Headlines and Insight from the Qui Tam Perspective

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Last Entry: October 30, 2009 at 21:11:52

New Report Suggests Waste, Including Health Care Fraud, Is One Third the Health Care Budget

Posted on October 30, 2009
Keith Olbermann reported on MSNBC’s Countdown October 27 that President Obama has said that eliminating waste could pay for most of any health care reform package. But critics disagree. Those critics might be more than a little wrong. Olbermann says a new study suggests the President might have underestimated just how much waste there is...

President Obama Vows to Eliminate Healthcare Fraud and Reduce Waste

Posted on September 10, 2009
On Wednesday, September 9, 2009, President Barack Obama addressed Congress on the current debate over healthcare reform. In his speech, the President vowed he would eliminate ?the hundreds of billions of dollars in waste and fraud.? Under his plan, an independent commission of doctors and medical experts would be appointed the task of uncovering fraud [...

OIG Chief Counsel Gives Senate Testimony on Commercial Sponsorship of Continuing Medical Education

Posted on August 31, 2009
On July 29, 2009, Lewis Morris, chief counsel, Office of Inspector General (OIG) testified before the Senate about the risks of commercial sponsorship of continuing medical education (CME) and solutions for ensuring a more bona fide educational purpose...

Fighting Medicare Fraud

Posted on July 30, 2009
PBS business news correspondent Jeff Yastine interviewed Marcella Auerbach for his broadcast news segment titled, ?Dozens Arrested For Medicare Fraud,? which aired nationally during the July 30, 2009 nightly news cast. Marcella was also quoted in Jeff?s related news article titled, ?Fighting Medicare Fraud...

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Teaching Hospital Settles Physician Billing Case

Posted 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 [...

Physicians Snared By Growing Medicare Fraud Strike Team

Posted 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 [...

Inspector general addresses health care fraud

Posted on June 26, 2009
On Thursday, June 25, 2009, Daniel R. Levinson presented testimony on the Office of the Inspector General’s (OIG’s) role in addressing health care waste, fraud and abuse, as well as its plans for health care reform. Talking before the Subcommittee on Health of the House Energy and Commerce Committee Levinson, inspector general of the U...

Miamians Charged in Elaborate Medicare Fraud

Posted on June 24, 2009
Federal prosecutors charged eight conspirators in Miami with defrauding the U.S. healthcare system by creating phony clinics that churned out $100 million of medical bills in five states, according to a June 23, 2009 Reuters news article. The sophisticated scheme involved fake clinics, which in reality were empty storefronts or post office boxes–none providing any actual [...

Double-billing Settlement Highlights Whistleblower Concerns

Posted on June 23, 2009
Earlier this week, the University of Medicine and Dentistry of New Jersey agreed to pay the federal government $2 million to settle a whistleblower lawsuit alleging that it bilked Medicaid in a double-billing scheme that started in 1993 and ended in 2003, according to the Department of Justice...

UMDNJ to Pay U.S. $2 Million for Allegations of Medicare Fraud

Posted on June 09, 2009
The University of Medicine and Dentistry of New Jersey (UMDNJ) has agreed to pay the United States $2 million to resolve federal civil fraud allegations that its hospital defrauded Medicaid, the Justice Department announced June 9, 2009, according to a press release on PR Newswire...

Alleged False Claims Act Violations Land Minnesota Hospitals in Hot Water

Posted on May 22, 2009
Three HealthEast Care System hospitals have agreed to pay the United States $2.28 million to settle allegations that the health care facilities submitted false claims to Medicare, the U.S. Justice Department announced May 21, 2009. According to the DOJ press release, the settlement resolves allegations that the St...

Texas-Based Nursing and Rehabilitation Centers to Pay U.S. $4 Million for Alleged False Medicare and Medicaid Billings

Posted on May 21, 2009
Regency Nursing and Rehabilitation Centers Inc. nursing home chain will pay the United States $4 million to settle allegations that Regency submitted false claims to Medicare and the Texas Medicaid program, the Justice Department and the U.S. Attorney’s Office for the Southern District of Texas announced May 21, 2009...

Attorney General and HHS Secretary Announce New Interagency Health Care Fraud Prevention and Enforcement Action Team

Posted on May 21, 2009
The government has created a new interagency health care fraud prevention and enforcement team, according to a May 20, 2009 announcement by Attorney General Eric H. Holder, Jr. and Health and Human Services (HHS) Secretary Kathleen Sebelius. The new interagency effort, called the Health Care Fraud Prevention and Enforcement Action Team (HEAT), is charged with combating [...

Homecare Association Presents 13-point Plan to Eliminate Medicare Waste, Fraud and Abuse

Posted on May 07, 2009
In April 2009, the American Association for Homecare presented Congress with its 13-point legislative action plan, called the Medicare Anti-Fraud Legislative Plan, aimed at eliminating waste, fraud and abuse in Medicare’s home medical equipment sector...

Wellcare to Pay $80 Million in Medicaid Fraud Case

Posted on May 06, 2009
Executives and employees at WellCare Health Plans Inc. engaged in an elaborate scheme to defraud the Florida Medicaid program and the Florida Healthy Kids Corporation, according to a press release by the U.S. Department of Justice. In order to avoid a health care fraud conviction on these charges WellCare must, among other things, consent to [...

Sheehan Calls for Aggressive Actions against Medicare, Medicaid Fraud and Abuse

Posted on April 23, 2009
On April 22, 2009,� New York Medicaid Inspector General James Sheehan testified before the U.S. Senate Committee on Homeland Security and Governmental Affairs Subcommittee on Medicare and Medicaid about waste and fraud. New York was the most successful state in the nation in Medicaid program integrity in the past year, measured by fraud and abuse [...

Houston Hospital to Pay U.S. More Than $9 Million for Alleged Medicare Fraud

Posted on March 27, 2009
Methodist Hospital in Houston has agreed to pay the United States $9.99 million to settle allegations that it defrauded the federal Medicare program, the U.S. Department of Justice announced March 26, 2009. The government alleged that, between January 2001 and August 2003, Methodist improperly inflated charges for inpatient and outpatient care to make its costs for [...

$10 million Medicare fraud scheme involves Miami HIV Infusion Clinics

Posted on March 23, 2009
Four Miami-area physicians and medical assistants pleaded guilty March 23, 2009 to a $10 million Medicare fraud scheme involving HIV infusion clinics, according to a Department of Justice (DOJ) press release.� The four defendants worked at Midway Medical Center Inc...

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

Posted 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...

Medicare Fraud Boosts Home Health Spending, According to New GAO Report

Posted on March 13, 2009
Medicare spending on home health was $12.9 billion in 2006?that?s up 44% since 2002, according to Government Accountability Office (GAO) report released March 13, 2009. Upcoding, by home health agencies, as well as other fraudulent and abusive practices, such as kickbacks and billing for services not rendered, contributed to the rise in Medicare spending for [...

Oops! CMS Paid Millions to Medicare Advantage Plans after Enrollees Died

Posted on March 11, 2009
The Centers for Medicare and Medicaid Services (CMS) paid about $4.4 million to Medicare Advantage plans on behalf of enrollees, after those enrollees had died. CMS made the improper payments for 2,657 deceased enrollees between January 2003 and April 2007, according to the March 2009 report “Review of Medicare Payments to Managed Care Plans on [...

New York Hospital Agrees to Settle Qui Tam

Posted on March 06, 2009
The Government announced today that a former employee� of Victory Memorial Hospital?s qui tam lawsuit has resulted in a settlement with the United States of at least $2.3 million to resolve claims that the hospital defrauded the Medicare program. The Medicare Fraud settlement covers allegations that Victory Memorial submitted Cost Reports for 1996 and 1997 that [...

President?s Proposed 2010 Budget Aims to Increase Revenue by Reducing Fraud, Abuse

Posted on March 05, 2009
President Obama?s fiscal year 2010 proposed budget estimates that reducing health care fraud, waste and abuse could save the government about $5 billion in a decade?s time. The budget pledges nearly $1.5 billion for its Health Care Fraud and Abuse Control Program (HCFAC), including a $311 million increase in HCFAC funding...

Feds Seek Damages from Scios

Posted on February 22, 2009
The federal government intervened in two San Francisco lawsuits Thursday and accused a Johnson & Johnson subsidiary of defrauding Medicare and other federal health programs by promoting a cardiac drug for uses that the Food and Drug Administration has not approved...

FDA approves Ranbaxy Laboratories? drugs despite allegations of fraud and more

Posted on February 20, 2009
FDA has approved 18 products, including generic versions of commonly used cholesterol and allergy medications, by pharmaceutical giant Ranbaxy Laboratories, even though the government has accused the company of serious violations. The government agency issued warnings to Ranbaxy late last year for more than 30 of the pharma giant?s generic drugs, produced at two plants in [...

Two Chicago Cardiologists Charged With Medicare Fraud

Posted on February 10, 2009
Chicago, Illinois?� Cardiologist Sughil Sheth received $13.4 million over a period of five years (2002-2007) by billing Medicare for reimbursement of extensive cardiac care that was not, according to U.S. Attorney Patrick Fitzgerald, ever performed.� Sheth allegedly performed Medicare Fraud by hiring individuals to falsify patient names, insurance data, and dates in order to bill [...

HOSPITALS ACCUSED OF $50 MILLION MEDICARE FRAUD

Posted on January 19, 2009
Albany N.Y.?According to The Associated Press, recent lawsuits allege that four New York hospitals (Columbia Memorial Physicians Hospital, Long Beach Medical Center, New York Downtown Hospital, St. Joseph?s Medical Center) paid kickbacks to elicit patients for drug treatment programs and billed Medicaid for unnecessary services that lacked state certification...

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

Posted on November 04, 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 [...

$60 Million Settlement by CoxHealth (Lester E. Cox Medical Centers) for Healthcare Fraud

Posted on November 04, 2008
Improperly billed claims paid by Medicaid payments has resulted in a $60 million settlement by CoxHealth. This settlement resulted from allegations that beginning as far back as January 1996, CoxHealth allegedly entered into prohibited financial agreements that violated Medicare cost report requirements, Stark Laws and the Anti-Kickback Statute...

Government Cracks Down on Violators as Medicare Fraud Increases

Posted on January 10, 2008
The federal government is about to announce a national effort to fight Medicare fraud by looking at billing by medical equipment suppliers. There has been an increase in Medicare fraud, particularly in Southern California and South Florida where Medicare are plenty...

HealthSouth and Its Doctors Pay Nearly $15 Million Settlement to Government

Posted on January 02, 2008
� HealthSouth is the nation’s largest provider of inpatient rehab services and was formerly one of the largest providers of outpatient rehab services, ambulatory surgery services and diagnostic imaging services until it sold those businesses earlier this year...

Texas Medical Equipment Supplier Indicted for Medicare Fraud

Posted on October 22, 2007
On October 17, 2007, Florence Ubak-Offiong was indicted on health care fraud charges including violations of the anti-kickback statute. The indictment alleges that through her medical supply company fraudulently overbilled Medicare for equipment received on behalf of customers located throughout the state of Texas...

Medicare Scam Results in Indictment of California Doctor and Employee

Posted on September 24, 2007
Dr. Kenneth Ferguson, a physician of record at Huntington Beach Medical Center which operated from July through October 2004 was indicted by a federal grand jury in Santa Ana, California along with his employee Olena Kulakova for health care fraud. According to the allegations, Dr...

Pilot Program Targets Durable Medical Equipment Suppliers

Posted on August 29, 2007
The federal government has instituted a two-year pilot program, in Florida and California, targeting medical equipment suppliers in to root out those who defraud Medicare, by requiring them to reapply to the program. As the result of this program, sellers of durable medical equipment such as providers of artificial limbs, braces, splints and wheelchairs need [...

South Florida Company Bilks Medicare Out of $170 Million

Posted on August 28, 2007
R&I Billing was charged with fraudulently billing Medicare $170 million for infusions of HIV drugs. The scheme worked as follows: “From roughly October 2002 through April 2006, HIV clinics in South Florida serviced by R&I Billing allegedly provided bills to Medicare that indicated patients were being injected with excessive amounts of HIV medications?Based on claims [...

OIG says it will make Recoveries of almost $3 Billion for HHS Programs in First Half of FY 2007

Posted on June 15, 2007
The Department of Health and Human Services Office of Inspector General Semiannual Report to Congress reports that the OIG will recover nearly $3 billion for Medicare fraud reports that the OIG will recover nearly $3 billion for , Medicaid fraud , and other healthcare federally-funded programs for the first half of fiscal year 2007...

Florida Medicare Fraud Hits New Low With Fake HIV Clinic

Posted on June 15, 2007
Twelve people were arrested in connection with a $5 million scam for collecting Medicare and Medicaid benefits for phony HIV treatments.� The charges included allegations that HIV positive patients were recruited by the Belle Glade Family Health Group and were paid $25 per visit...

The Decline in FDA Enforcement Activity

Posted on June 04, 2007
Congressman Waxman’s United States House of Representatives Committee on Government Reform issued a report entitled “Prescription for Harm/The Decline in FDA Enforcement Activity” in June 2006. Enforcement is down and our FDA-related filings are up...

South Florida Medicare Fraud Causes Government to Take A Closer Look

Posted on June 04, 2007
Federal officials have documented in excess of $140 million in Medicare fraud in South Florida alone.� With 38 arrests in a recent sting operation, the government has said it will take a closer look at other providers of medical equipment.� Health and Human Services Mike Leavitt has said that increased enforcement efforts nationally could save [...