Medicaid Provider Fraud

Medicaid provider fraudWhen we get sick, the first thing that we do is ask for professional help, without even admitting that we might become victims of a Medicaid Provider Fraud. Medicaid providers, as a symbol of care and custody, usually inspire trust and confidence, making us expect that our provider will supply us nothing, but help.

Unfortunately, statistics say that Medicaid Provider Fraud is a well-spread phenomenon among scammers, which steal billions of dollars annually. Moreover, the Federal Government also counts on physicians to submit accurate and truthful claims information, by creating such programs as Medicare, Medicaid, and other health care policies. Let’s have a deeper insight into the concept of this type of fraud and analyze the possible countermeasures.

WHO CAN BE CHARGED WITH MEDICAID PROVIDER FRAUD?

First of all, every member of the health care community (individual, corporation, or other entity paid by Medicaid) can potentially become a scammer, including nurses, nurse aides, nursing homes, pharmacies, ambulance and transportation companies, chiropractors, podiatrists, licensed professional counselors, community care service providers, dentists, hospitals, medical equipment companies, speech therapists and others.

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Things You Should Know About Healthcare Programs Recipient Fraud

medicaid fraudEasy money have always been an attractive incentive for the majority of people. Some of us, are more likely to think that a little fraud will not lead to serious cases of criminal prosecution. For those who could not resist temptation – here are several things you should know about Medicaid Recipient Fraud.

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Michigan Oncologist Dr. Farid Fata – Medicare Fraud, Villian or Cancer Patient Savior?

 On August 6, 2013, a Criminal Complaint was filed against Michigan Oncologist Dr. Farid Fata in Federal Court in the county of Oakland in the Eastern District of Michigan.  The Defendant was charged by the U.S. Government with Healthcare Fraud in violation of 18 U.S.C. 1347.

In an affidavit in support of the Complaint, Special Agent Brian Fairweather who was employed by the Federal Bureau of Investigation (“FBI”) alleges the following violations:

  • Healthcare Fraud – 18 U.S.C. 1347
  • Distribution of Controlled Substances – 21 U.S.C. 841(a)(1)
  • Money Laundering – 18 U.S.C. 1956 and 18 U.S.C. 1957
  • Payment or receipt of Healthcare Kickbacks – 42 U.S.C. 1320a-7(b)(1)(A) and 42 U.S.C. 1320a-7(b)(2)(A)

More specifically, the Complaint alleges the following:

  • Administration of unnecessary chemotherapy to patients in remission
  • Deliberate misdiagnosis of patients having cancer to justify unnecessary cancer treatment
  • Administration of chemotherapy to end-of-life patients who will not benefit from the treatment
  • Deliberate misdiagnosis of patients with cancer to justify expensive testing
  • Fabrication of other diagnoses such as anemia and fatigue to justify unnecessary hematology treatments
  • Distribution of controlled substances to patients without medical necessity

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Find Out if Your Medical Service is Covered By Medicare!

According to the Official U.S. Government Site for Medicare, the Medicare program guarantees health insurance for people ages 65 or older and people under 65 with certain disabilities as well as people of any age with End – Stage Renal Disease (ESRD) (permanent kidney failure that requires a regular course of dialysis or a kidney transplant).

The whole Medicare social insurance program is divided into different parts where each of the part covers specific services:

Medicare Part A applies to Hospital Insurance and covers inpatient care in hospitals and skilled nursing facility, hospice, and home health care.

Medicare Part B applies to Medical Insurance and covers not only doctors’ and other health care providers’ services, outpatient care, durable medical equipment, and home health care, but also some preventive services to help maintain your health and to keep certain illnesses from getting worse (for example, preventive services include Pap tests, flu shots, and screening mammograms).

Medicare Part C, or Medicare Advantage, offers health plan options run by Medicare-approved private insurance companies, helps to get the benefits and services covered under Part A and Part B, and may include extra benefits for an extra cost. Most Medicare Advantage Plans cover Medicare prescription drug coverage (Part D).

Medicare Part C, or Medicare Prescription Drug Coverage, covers the cost of prescription drugs or may help lower your prescription drug costs and help protect against higher costs in the future.

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Health Care Fraud: Sales Force Manipulation

In a recent article written by Bernard Vaughan and Jonathan Stempel entitled: U.S. sues Novartis, alleging kickbacks to pharmacies, Reuters reported that US government accuses Novartis Pharmaceuticals Corp. of paying kickbacks to pharmacies to switch kidney transplant patients from competitors’ drugs to its own and to oppose the use of a cheaper, generic immunosuppressant drug.

Since 2005 at least 20 pharmacies have got illicit payments from Novaris AG, a Swiss drug maker, to push up sales of its immunosuppressant drug Myfortic, said U.S. Attorney Preet Bharara.

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Hospice of the Comforter Inc. Charged With Medicare Fraud

 

In an article posted on The Employment Law Group Blog entitle:  Justice Department Joins False Claims Act Medicare Fraud Lawsuit, it was reported that the Justice Department will join the False Claims Act qui tam lawsuit filed against Hospice of the Comforter Inc. (HOTCI) by Douglas Stone, HOTCI’s former vice-president of finance. Stone’s suit alleges that HOTCI engaged in fraudulent Medicare billing.

Allegedly the Company’s CEO had verbally directed employees to admit for hospice care patients with Medicare coverage without first fully qualifying whether in fact those patients were eligible for hospice benefits.  After performing an audit, the Company had to discharge at least 150 patients after determining that they were not eligible for Medicare hospice benefits.