Medicare Fraud 101

Archive for the 'Medicare Fraud' Category

Government Cracks Down on Violators as Medicare Fraud Increases

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. The crackdown is a nationwide effort by the U.S. Department of Health and Human Services as part of its plan to require medical equipment suppliers to face stricter background checks and inspections with short notice. These Medicare changes are bound to lead to the revocation of Medicare billing privileges and prosecutions for companies engaged in Medicare fraud.

To read the full story click here or on the following for more about Medicare Fraud.

If you believe you have information concerning Medicare fraud and want to read more about Nolan & Auerbach, P.A. you may contact us.

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

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.  However, illegal Kickbacks and False Claims have cost HealthSouth Corporation and two of its physicians nearly $15 million.  This is what is took to settle allegations that false claims were submitted to the government and illegal kickbacks were paid to orthopedic surgeons who referred patients for care to HealthSouth Corp. hospitals, outpatient rehab clinics and ambulatory surgery centers.  The Department of Justice is continuing to investigate other improper physician referral relationships.

The Anti-Kickback Statute arose out of congressional concern that payoffs to those who can influence healthcare decisions will result in goods and services being provided that are medically unnecessary, of poor quality or even harmful to a vulnerable patient population.  To deter these harms, Congress enacted a per se prohibition against the payment of kickbacks in any form, regardless of whether the particular kickback gave rise to over utilization or poor quality of care.
 

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o read the full story click here or click the following for more about the False Claims Act and Anti-kickback Laws.

If you believe you have information concerning a violation of the False Claims Act and want to read more about Nolan & Auerbach, P.A. you may contact us. 

Texas Medical Equipment Supplier Indicted for Medicare Fraud

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 supply companies are coming under continuing scrutiny for their fraudulent activities.To read more click here or visit Nolan & Auerbach law firm’s website.

Medicare Scam Results in Indictment of California Doctor and Employee

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. Ferguson and his employee Kulakova would bill Medicare for physician services for care rendered to patients by Kulakova. Kulakova had no medical license in the State of California even though she held herself out to be either a doctor or a physician’s assistant. Both Dr. Ferguson and Kulakova caused Medicare to be billed for comprehensive evaluation and management visits for patients even though face time with patients lasted only 5 to 10 minutes as opposed to the usual 25 to 45 face to face time with a patient. In addition, it is alleged that both Dr. Ferguson and Kulakova directed and caused kickbacks to be paid to patients to come to the Huntington Beach Medical Center for Services.

To read more about this case click here; or click here to read more about medicare fraud and qui tam actions.

Pilot Program Targets Durable Medical Equipment Suppliers

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 to reapply and expect spot visits to make sure that the companies exist and are able to provide the equipment.

Leslie Norwalk, Acting Administrator of the Centers for Medicare and Medicaid Services stated, “The point is to keep fraud providers out of the program before they can rip us off. With re-enrollment and multiple surprise visits, we think we can stop the fraud.”

It is hoped that the success of the program will lead to its expansion to other parts of the country. In January 2006 alone, spot visits to 480 suppliers in South Florida, resulting in 191 firms having their billing rights revoked.

To read more on this topic click here or contact Nolan & Auerbach.

South Florida Company Bilks Medicare Out of $170 Million

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 filed byR&I Billing, Medicare paid more than $100 million for these fraudulent services” according to a joint statement issued by the Department of Justice and Health and Human Services.

Medicare spending in 2006 totaled $40 billion for the care of 43 million elderly and disabled Americans. Infusion therapy provides medicines intravenously outside of a hospital or nursing home for many such beneficiaries. There are approximately 1,200 providers of infusion therapy in the United States.

To read more click here.

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