Medicare Fraud 101

Archive for August, 2007

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.