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Medicare Fraud 101





Last Build Date: Thu, 30 Mar 2017 17:11:59 +0000

 



Hospital Service Provider Pays $60 Million to Settle Healthcare Fraud Allegations

Thu, 30 Mar 2017 17:11:59 +0000

Recently, the Department of Justice announced that TeamHealth Holdings (successor in interest to IPC Healthcare Inc.) has agreed to pay $60 million to resolve upcoding allegations by billing Medicare, Medicaid, the Defense Health Agency and the Federal Employees Health Benefits Program for higher and more expensive levels of medical service than were actually performed.  The […]

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Medicare Dollars Are Still Siphoned Through Ambulance Fraud

Thu, 16 Feb 2017 19:07:09 +0000

“Ambulance service companies should be focused on the needs of the patients,” said HHS Office of Inspector General Special Agent in Charge Phillip Coyne. He continued: Billing Medicare for ambulance rides that were unnecessary or at a higher rate than could be medically justified is unacceptable. Together with our law enforcement partners, we will seek out and stop […]

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Civil Health Care Fraud Recoveries Have Exceeded $2 billion for the Seventh Consecutive Year

Mon, 23 Jan 2017 18:57:27 +0000

Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division, announced recently that the Department of Justice obtained more than $4.7 billion in settlements and judgments from civil cases involving fraudulent claims against the government in fiscal year 2016. This is the third highest annual recovery in False Claims Act history, […]

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Anti-Kickback Statute Reaches Consultants Who Seek to Improperly Influence Healthcare Providers

Tue, 18 Oct 2016 19:39:12 +0000

The vast majority of False Claims Act settlements involving kickback allegations have been instances where healthcare providers have allegedly received kickbacks for utilizing a manufacturer’s product. Recently, however, there have been a few successful recoveries where the alleged kickback recipient was not the ultimate decision-maker or even healthcare provider. While this is an expansion of […]

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Government Recovers Millions from Hospital System that Allegedly Wrongfully Retained Medicaid Overpayments for Over 60 Days

Tue, 13 Sep 2016 14:53:45 +0000

Recently, the Justice Department announced a first-of-its-kind settlement involving allegations that a health system violated the False Claims Act by retaining Medicaid overpayments for more than 60 days after identifying that overpayments were made. This $2.95 million settlement with Mount Sinai Health System was the first settlement involving the Affordable Care Act provision that created […]

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Are Medically Unnecessary Tests Driving Growth of In-Office Procedures?

Wed, 24 Aug 2016 19:57:06 +0000

In a recent Wall Street Journal article titled, “In-Office Testing by Doctors Lifts Medicare Costs,” it was revealed that a sizeable chunk of the Medicare dollars are now going to physicians who utilize newly minted in-office medical devices. In fact, the WSJ’s analysis of recently released Medicare billing data showed that four of the top […]

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Are Copayment Assistance Nonprofits to Funneling Kickbacks to Patients?

Fri, 01 Jul 2016 15:51:47 +0000

In recent years, the federal government has reviewed the issue of copayment assistance organizations that purport to help Medicare and Medicaid beneficiaries with their pharmaceutical copayments, but has not yet taken any public enforcement action to our knowledge. Now, the media seems to be taking a closer look, as seen in a recent Bloomberg article […]

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Are Hospitals Pressuring ER Physicians to Inappropriately Admit Patients?

Fri, 24 Jun 2016 15:37:38 +0000

Over the last few years, the government has devoted substantial resources to pursue hospitals that inappropriately admit patients to inpatient stays. This month, the government intervened after initial declaration in a qui tam case against 14-hospital health system Prime Healthcare. The lawsuit included allegations that senior management would: criticize Emergency Department doctors and demand their […]

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Unproven Promotion and Performance of Stem Cell Treatments

Thu, 03 Mar 2016 16:35:08 +0000

In October 2015 the FDA issued the following fraud warning on stem cell therapies: FDA has not approved any stem cell-based products for use, other than cord blood-derived hematopoietic progenitor cells (blood forming stem cells) for certain indications. The appropriate, clinically proven and beneficial use of stem cell therapies is updated and published by reliable […]

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Independent Diagnostic Testing Facilities Fraud

Tue, 23 Feb 2016 20:06:34 +0000

An Independent Diagnostic Testing Facilities (IDTF) is a facility that is separate and independent from a hospital or physician office, where patients go to obtain certain x-rays, scans, and other imaging and diagnostic tests that are ordered by treating physicians.  For more than a decade, various HHS-OIG reports and advisory opinions have highlighted IDTF fraud […]

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