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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

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 [...

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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 [...

Two Chicago Cardiologists Charged With Medicare Fraud

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...

Hospitals Accused of $50 Million Medicare Fraud

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...

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

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

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...

Government Cracks Down on Violators as Medicare Fraud Increases

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...

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...

Texas Medical Equipment Supplier Indicted for Medicare Fraud

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...

Medicare Scam Results in Indictment of California Doctor and Employee

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 [...

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