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Qui Tam

Medicare Fraud 101

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

Post Frequency: 4.5/day

Last Entry: June 28, 2017 at 16:46:39

Hospitals in Seven States to Pay more than $9.4 Million for Unnecessary Inpatient Kyphoplasties

Posted on May 18, 2010
Nine hospitals in seven states will pay the U.S. more than $9.4 Million to settle allegations that the health care facilities submitted false claims to Medicare, the U.S. Department of Justice announced May 17, 2010. The hospitals are alleged to have overcharged Medicare between 2000 and 2008 when performing kyphoplasty, a minimally-invasive procedure used to treat [...

OIG Site Recognizes MFCU?s

Posted on April 26, 2010
Many Medicare Fraud cases are jointly worked by the feds and the states, as often the cases are national in scope and involve Medicaid utilization as well as Medicare. To display the often important role played by State Medicaid Fraud Control Units (MFCUs), the OIG has developed a new section on its website specifically concerning [...

Rush University Medical Center to Pay More than $1.5 Million

Posted on March 30, 2010
Rush University Medical Center has agreed to pay $1,547,200 plus interest to resolve allegations that the facility violated the False Claims Act, the U.S. Department of Justice (DOJ) announced March 9, 2010. Rush is alleged to have submitted false claims to Medicare during the period 2000 through 2007 by entering into certain leasing arrangements for [...

Robert Wood Johnson University Hospital to Pay $6.35 Million to Resolve Medicare Fraud Allegations

Posted on March 22, 2010
Robert Wood Johnson University Hospital Hamilton, a New Jersey-based hospital, has agreed to pay $6.35 million to settle allegations that the hospital defrauded Medicare, the United States Department of Justice (DOJ) announced March 19, 2010. Two lawsuits filed against the Hamilton, N...

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President Denounces Health Care Fraud Yesterday

Posted on March 11, 2010
During a March 10, 2010 rally in St. Charles, Mo., President Obama blamed health care fraud, waste and abuse for costing taxpayers almost $100 billion in 2009, according to an Associated Press story published that day on Yahoo News. He said such payments, which include Medicare fraud and Medicaid fraud, amounted to more than is spent [...

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

Posted on February 03, 2010
President Obama’s fiscal year 2010 proposed budget estimates that reducing health care fraud, waste and abuse could save the government about $10 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...

National Dental Management Company Pays $24 Million to Resolve False Claims Act Allegations

Posted on January 24, 2010
The United States has settled False Claims Act allegations against FORBA Holdings LLC, a dental management company that provides business management and administrative services to 69 clinics nationwide known as “Small Smiles Centers.” Under the agreement, FORBA will pay the United States and participating states $24 million, plus interest, to resolve allegations that it caused [...

Medicare Fraud Strike Force Charges 30 Individuals with Medicare Fraud and Expands Operations

Posted on January 12, 2010
Thanks to the Medicare Fraud Strike Force, 30 people have been charged in three cities for their alleged roles in schemes to submit more than $61 million in false Medicare claims, according to a Dec. 15, 2009 press release by the Federal Bureau of Investigation (FBI)...

Spectranetics Corporation to Pay $5 Million to Resolve Allegations of Health Care Fraud

Posted on January 08, 2010
Spectranetics Corporation, a medical device manufacturer, has agreed to pay the United States $4.9 million in civil damages, as well $100,000 forfeiture to resolve claims against the company, the United States Department of Justice (DOJ) announced December 29, 2009...

Texas Hospital to Pay U.S. Nearly $1 Million for Allegations it Violated the False Claims Act

Posted on January 07, 2010
Arlington Memorial Hospital, Arlington, Texas, has agreed to pay the U.S. $990,509.50 to resolve allegations that it violated the civil False Claims Act, according to a Jan. 4, 2010 announcement by U.S. Attorney James T. Jacks of the Northern District of Texas...

Nation?s Largest Inpatient Rehab Services Provider Allegedly Paid Illegal Kickbacks to L.A. Orthopedic Clinic

Posted on December 04, 2009
HealthSouth Corporation, the nation’s largest provider inpatient rehabilitative healthcare services, allegedly paid illegal kickbacks to the Kerlan Jobe Orthopaedic Clinic, a sports medicine clinic in Los Angeles. As a result, the Kerlan Jobe Orthopaedic Clinic has agreed to pay the United States $3 million to settle these allegations, the United States Department of Justice announced [...

Grassley Introduces Bill to Fight Medicare Fraud

Posted on November 16, 2009
Working to protect taxpayers and Medicare beneficiaries, U.S. Senator Chuck Grassley has introduced legislation to give the federal government more time to pay Medicare providers when waste, fraud and abuse is suspected, according to a November 16, 2009 press release on IowaPolitics...

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...

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...

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