Medicare Fraud 101

$50 Million Medicare Fraud Surrounds Clinics, Pharmacies and Durable Medical Equipment Companies

Did Medicare Fraud Settlement Cause A New Jersey Hospital To Close Its Doors?

Medical Biller Nabbed in Medicare Fraud Scheme

New York Hospital Appears to be Under Investigation for Possible Health Care Fraud and Kickbacks

Westchester Medical Center received a subpoena on January 31, 2007 from Office of Inspector General of the U.S. Department of Health and Human Services, asking for information going back to 1997, primarily related to the hospital’s relationships with its doctors.  Under Stark and  anti-kickback laws, hospitals are not permitted to give physicians inducements for patient referrals.  

To see the full story click here or to learn more click here.   

Radiology Center Kickbacks Are A Nationwide Problem

The Illinois Attorney General intervened on January 18, 2007 in a lawsuit against a number of Chicago radiology centers (including MIDI, LLC, a Virginia company that operates 13 Open Advanced MRI facilities in Illinois) over their payments of kickbacks to referring doctors. The physicians allegedly would enter into sham lease agreements with the radiology centers allowing them to pay a reduced rate for MRI and CT scans, charging the patient?s insurance that higher rate and then pocketing the difference. “Illinois has a clear policy against kickbacks, and making payments to doctors for referral of patients is illegal, no matter how those payments are disguised,” Attorney General Lisa Madigan said in our statement. “Our investigation revealed evidence showing that this practice occurs among doctors and radiology centers in Illinois. This is an illegal practice that must stop.” While only 11 companies that operate MRI centers were named in the lawsuit, the Attorney General’s Office believes this fraudulent scheme stretches “beyond Illinois and across the country.”

To read more about the story, click here.

To read more about Medicare fraud and kickbacks, click here.

How to be a Successful Whistleblower Under the False Claims Act and Still Have Money for Lunch

A corporate insider is in a unique position to know the details about how their employer has cheated the United States Government. Nothing beats the knowledge an insider can impart. Whistleblowers are the real heroes in the fight against fraud. The person (plaintiff) who brings an action under the False Claims Act is called a “relator.”

The False Claims Act enables people to expose fraud and was originally enacted in 1863 for that very purpose. In general, the False Claims Act covers fraud involving any federally funded contract or program, with the exception of income tax fraud. The healthcare and defense industry have traditionally been the top two areas involving prosecution under the False Claims Act.

The word alone of a whistleblower is simply not enough. A whistleblower needs to organize and collect evidence of the fraud so there is a sound basis of proof to support the allegations.

The types of allegations for which a corporate insider needs evidence under the False Claims Act include corporate involvement on the following:

The False Claims Act is intended to reach all fraudulent activity which causes the government to pay out too much money. Some common forms are claims for goods or services not provided, or provided in violation of contract terms, specification, statute, or regulation (such as in conjunction with kickbacks). Each and every claim submitted under a contract or other agreement which was originally obtained by means of false statements, falsities, or in knowing violation of any statute or applicable regulation, constitutes a false claim.

KEEP QUIET AND SHARE YOUR CONCERNS WITH NO ONE until you have spoken with an attorney who specializes in the False Claims Act. Many before you have spoken up only to have become summarily “let go” or demoted. Speak up and you might not have money for lunch at the end of the day.

Medical Supply Company Owner Sentenced for Medicare Fraud

A scheme to defraud Medicare resulted in a three year prison term for the owner of medical supply companies in Kansas City and Raytown, Missouri, who sent claims to Medicare totaling more than $5 million dollars for power wheelchairs but substituted a less expensive motortized scooter to nearly 1,000 beneficiaries. His co-defendants, which included two former physicians, will be sentenced; each facing as much as 10 years in prison and additional fines and restitution.

To read more on this article click here.