Medicare Fraud 101

Health Care Employers Required to Educate Employees on False Claims Act Whistleblowing

Employee Section 6032 “Employee Education About False Claims Recovery” requires that entities receiving or making more than $5 million in annual payments under a state Medicaid plan,must, as a condition of participation, create written compliance policies designed to educate employees, contractors and agents about false claims, false statements and whistleblower protections under applicable federal and state fraud laws.

To read more click here.

South Carolina Medical Center to Pay $3.75 Million Fine

As a result of violating Stark Laws and submitting improper bills to Medicare, Medicaid and TRICARE, the Marion County Medical Center in South Carolina will pay $3.75 Million arising out of a qui tam False Claims Act case filed by a whistleblower. For more information click here.

False Certification Case Settled for $9 million

This case settlement is a recent example of false claims act liability based upon false certification. Although this is not a healthcare fraud case, we point out that false certification in the healthcare fraud field is still probably going strong and the basis for liability.To see a brief story, click here.

Medicare Fraud - Motorized Wheelchairs

An Arkansas physician was sentenced to prison for his role in a Medicare fraud case involving motorized wheelchairs. The physician convinced his elderly patients to seek motorized wheelchairs which were paid for with Government funds. The wheelchair supplier was allegedly paid kickbacks as part of the scheme. For more information,  click here.

Qui Tam Lawsuits Stike Hard at Healthcare Fraud

New Jersey Hospital Owes the Feds $85.7 Million

  The  OIG recently released an Audit Report, “Review of Medicaid Disproportionate Share Hospital Payments to University Hospital, University of Medicine and Dentistry of New Jersey: July 1, 1995, Through June 30, 2001.” The Audit revealed hundreds of millions in overpayments over a 5 year period due to the miscalculation of acute care DSH claims. The DSH claims  included in the hospital cost reports were false, triggering the overpayments. We will be seeing more DSH False Claims Act cases emerge soon. To see the Audit Report, click here.

Guess What Else is NOT a Top Priority of the FDA?

Answer: Monitoring postmarketing study commitments. 

The FDA lacks an effective system for monitoring postmarketing study commitments.  See the latest OIG Report, dated June 2006. 

The Decline in FDA Enforcement Activity

Congressman Waxman’s United States House of Representatives Committee on Government Reform issued a report entitled “Prescription for Harm/The Decline in FDA Enforcement Activity” in June 2006. Enforcement is down and our FDA-related filings are up. Any relationship?

Big Fines Levied For Violations of False Claims Act

In an article that appeared in The Baltimore Sun (Jonathan D. Rockoff, Improper sales of medicines targeted; Drug firms have paid fines of $3.5 billion since 2001 for wrongful promotions, The Baltimore Sun, May 7, 2006 at 1A), it is reported that since 2001, pharmaceutical companies prosecuted under the False Claims Act have paid nearly $3.5 billion in penalties. These penalties have resulted from the improper promotion by pharmaceutical companies, which include improper promotions and kickbacks. “…One reason the law has been effective is its reward to tipsters who can receive 15 percent to 30 percent of the penalties against a company …” To read more, see The Baltimore Sun.

Stark Violations Land Hospital in Hot Water

A May 9, 2006, Los Angeles Times article (Lisa Girion, U.S. Programs May Exclude Tenet Hospital, The Los Angeles Times, May 9, 2006 at C9), it was reported that, “… the Department of Health and Human Services’ Office of Inspector General notified Dallas-based Tenet that it intended to exclude Alvarado Hospital Medical Center in San Diego from the Medicare program, the Medicaid plan for the poor and all other federal health programs. The decision is based on allegations that Alvarado paid kickbacks over 10 years in order to induce doctors to refer patients for services and items paid for by the federal programs. ” This action follows two mistrials in which jurors were unable to agree as to whether Tenet, Alvarado Hospital Medical Center and a former employee were guilty of related criminal charges. To read more, see The LA Times.