Medicare Fraud 101
Archive for April, 2007
Allegations of False Claims Billings to Medicare Snags HealthEssentials Solutions
The United States has intervened in three whistelblower false claims actions involving HealthEssentials Solutions (HES), a Kentucky-based provider of geriatric care. The company’s nurse practitioners provided services to beneficiaries in nursing homes, assisted living facilities and private homes. HES had to select on its Medicare claim forms the level of service and location where the service was provided. The accusations specifically claim upcoding by HES to obtain a higher reimbursement from Medicare. Further, it is alleged that HES charged Medicare for unnecessary services. “The government’s intervention in this case demonstrates the Department’s continued commitment to stamp out fraudulent practices that threaten the integrity of the Medicare Trust Fund,” said Assistant Attorney General Peter D. Keisler, of the Department of Justice’s Civil Division.
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| Posted By Marcella Auerbach | Responces 0 |
| Category Medicare Fraud | Posted April 30th, 2007 |
$50 Million Medicare Fraud Surrounds Clinics, Pharmacies and Durable Medical Equipment Companies
The owner of three Miami, Florida medical equipment companies was convicted by a jury of Medicare fraud with sentencing scheduled for June 12th. This prosecution was part of a greater scheme which included kickbacks involving 23 clinics, 3 pharmacies and 3 durable medical equipment companies. According to R. Alexander Acosta, U.S. Attorney for the Southern District of Florida, the Medicare program was billed for more than $20 million with over half the money kicked back to six of Aguera’s co-defendants in exchange for bringing patients to the pharmacies. Patients were also paid for access to their Medicare information and for purchasing phony prescriptions from corrupt doctors to provide to the pharmacies. In addition, the three Miami pharmacies involved—Lily’s Pharmacy, Unimed Pharmacy and Prestige Pharmacy illegally compounded non-FDA approved medicine and then billed Medicare. To read more click here:
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| Posted By Marcella Auerbach | Responces 0 |
| Category Medicare Fraud | Posted April 9th, 2007 |
Regulatory Documents (PDFs)
- OIG Compliance Program Guidance for Hospitals
- OIG Supplemental Compliance Program Guidance for Hospitals
- OIG Compliance Program Guidance for the Durable Medical Equipment, Prosthetics, Orthotics & Supply Industry
- OIG Compliance Program Guidance for Hospices
- OIG Compliance Program Guidance for Clinical Laboratories
- OIG Compliance Program Guidance for Home Health Agencies
- OIG Final Compliance Program Guidance for Nursing Facilities
- OIG Final Compliance Program Guidance for Medicare+Choice Organizations
- OIG Compliance Program Guidance for Third Party medical Billing Companies
- OIG Pharma Compliance Program Guidance for Ambulance Suppliers
- OIG Guidance on Voluntary Disclosure of Healthcare Fraud
- HHS-OIG 2002 Work Plan
- HHS-OIG 2003 Work Plan
- HHS-OIG 2004 Work Plan
- HHS-OIG 2005 Work Plan
- HHS-OIG 2006 Work Plan
Nolan Law Firm Articles
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