News
The DOJ and HHS have announced the largest federal health care fraud takedown ever: The Medicare Fraud Strike Force has charged 111 people in nine cities, including health care providers and executives, with a total of over $225 million in fraud against Medicare.
The defendants are accused of conspiracy to defraud the Medicare program, false claims, kickback schemes, money laundering, and aggravated identity theft, all involving various medical treatments and services such as home health care, physical and occupational therapy, and medical equipment.
The Medicare Fraud Strike Force is a joint effort between DOJ and HHS which targets Medicare fraud through data analysis and community policing. Over the past two years, the force has expanded its efforts from two cities to nine, with the recent addition of Chicago and Dallas – representing a quadrupling of the number of strike force teams operating around the country.
For more information, see the full press release here.
February 21st, 2011
Twenty people, including three doctors, have been indicted on health care fraud, kickback and money laundering charges. The charges stem from a fraud scheme in which the individuals allegedly submitted over $200 million in false claims to Medicare for mental health services which were either medically unnecessary or not provided at all.
The defendants were all employed by or worked with American Therapeutic Corporation (ATC) and Medlink Professional Management Group Inc. Headquartered in Miami, ATC operates partial-hospitalization programs, an intensive form of treatment for mental illness, in seven locations throughout Florida. The defendants’ alleged fraudulent acts include manipulating the length of patients’ stays to maximize Medicare benefits and admitting patients with Alzheimer’s or extreme dementia who would not have benefited from the services provided. A lucrative kickback scheme and related money laundering operation are also included in the charges.
The full press release is available here.
February 18th, 2011
At the beginning of this month, the OIG launched a new initiative to focus public awareness on health care abuse and fraud by publishing the first-ever Most Wanted Fugitives List. Photographs and profiles of each of the ten most wanted fugitives are included, though OIG is currently seeking over 170 fugitives. The top ten most wanted account for more than $124 million of taxpayer money stolen through fraud.
Instructions for reporting information on fugitives is available on the website.
See the list here.
February 17th, 2011
On February 2, 2011, three senators introduced SB 33 into the North Carolina State Senate. The bill contemplates capping noneconomic damages for pain and suffering, limiting liability for providers of emergency services and allowing for periodic payments of large awards in lieu of lump sum payments. The bill also seeks to bifurcate trials into two phases to separate liability question from monetary damages.
The North Carolina General Assembly website provides this page through which the bill can be read and tracked.
February 9th, 2011
The Department of Health and Human Services and the Department of Justice recently announced that in FY 2010, health fraud prevention and enforcement efforts recovered over $4 billion of stolen taxpayer money.
This is the highest amount ever recovered against perpetrators of health care and Medicare fraud, and is a direct result of the current administration’s aggressive efforts to eliminate fraud, waste and abuse in the U.S. health care system.
The Health Care Fraud Prevention & Enforcement Action Team (HEAT) was created in 2009 for the purpose of cracking down on fraud and abuse of the system, and their efforts will continue with the new rules, authorized by the Affordable Care Act, aimed at proactively preventing fraud, waste and abuse in Medicare, Medicaid, and the Children’s Health Insurance Program.
These new rules include enhanced screenings and enrollment requirements, increased data sharing across government, expanded overpayment recovery efforts, and greater oversight of private insurance abuses.
For more information, see the full HCFAC annual report. Or visit http://www.StopMedicareFraud.gov/ for information on joint DOJ-HHS Strike Force activities. A fact sheet on the new rules is available at www.HealthCare.gov/news/factsheets.
February 4th, 2011
The Center for Medicare and Medicaid services has launched the first phase of an online physician directory available to the public. The directory, Physician Compare, can be found at www.medicare.gov/find-a-doctor.
The database is designed to aid Medicare patients in finding and comparing physicians, but the database is available to the entire public. Some of the available search criteria include geographical area, gender, and whether or not providers accept Medicare approved amounts as payment in full.
Physicians are urged to check their listings as this phase of the database has already been found to include incomplete and incorrect information. If your information is incorrect, or you are not listed at all, go to http://www.medicare.gov/find-a-doctor/provider-search.aspx. The “Note to Providers” at the top left of the screen leads to a page that will recommend ways to get the problem resolved.
January 24th, 2011
The Justice Department has reached a $6.3 million settlement with seven hospitals in six southeastern states in connection with allegations that the facilities made improper billings to Medicare.
The hospitals, located in Florida, Mississippi, Texas, South Carolina, North Carolina, and Alabama, are charged with performing kyphoplasty as an in-patient procedure to increase Medicare billings, when kyphoplasty could often have been safely and more cheaply performed as an out-patient procedure.
For more information, see the full press release.
January 5th, 2011
The HHS Office of the Inspector General has released its latest updated database of excluded and reinstated entities and individuals. This database contains the most current information to date and replaces the monthly LEIE database to date.
Instructions for downloading are included on the webpage.
Individuals and entities can be excluded for convictions of program fraud, patient abuse, licensing board actions, and default on Health Education Assistance Loans. Excluded individuals and entities are not permitted to participate in federally funded healthcare programs, including Medicare and Medicaid, which means no payment will be made to these providers for any services provided under such programs.
December 23rd, 2010
The Department of Health and Human Services Office of the Inspector General has released its semi-annual report to Congress. The report includes an announcement of expected recoveries of $25.9 billion for the fiscal year, made up of recommendations for better use of funds and audit and investigation receivables. The OIG also reports 3,340 new exclusions of individuals and entities from federal health care programs, which can involve convictions of fraud or abuse. The OIG attributes its achievements to unprecedented efforts to fight fraud and waste.
A summary news release is available from the HHS website.
The full semi-annual report is also available from the HHS website.
December 23rd, 2010
The U.S. Department of Justice reports that Abbott Laboratories Inc., B. Braun Medical Inc. and Boehringer Ingelheim Roxane Inc., along with affiliated entities, will pay $421 million in settlement of False Claims Act allegations. The manufacturers are charged with reporting inflated sale prices for various products in order to produce artificially high reimbursements from federal healthcare programs.
The government alleges it ultimately paid millions more in payments for these pharmaceutical products than it would have if the companies had reported accurate prices.
For more information, including an explanation of the scheme and the government’s efforts to fight fraud, see the full press release.
December 10th, 2010
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