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The Times-News: Two plead guilty to Medicare fraud from Mebane facility

  Two health facility managers in Burlington, NC, plead guilty for fraudulently billing the state for services they never provided. FROM THE TIMES-NEWS: Fuller and McLean pleaded guilty to charges that they submitted or aided and abetted the submission of claims to the N.C. Medicaid program between June 2007 and Nov. 2008 for mental services that were never provided. The claims’ total came to about $400,000, the release said. McLean and Fuller “paid cash to some Medicaid recipients in order […]

The Patriot-News: Harrisburg ambulance firm owner pleads guilty in alleged $740K Medicare fraud case

  The owner of a Harrisburg ambulance services company pleads guilty after facing indictments related to illegal billing. From The Patriot-News: …Sivchuk was indicted for allegedly billing Medicare illegally for non-emergency transports of Medicare clients to dialysis treatment centers. The claims were fraudulent, because the patients were ambulatory and the ambulance rides weren’t necessary, Smith said. He said investigators determined that Sivchuk sent doctored trip sheets with forged signatures to Medicare for reimbursement. The terms of Sivchuk’s plea agreement call […]

Fox News: South Texas, Second Most Notorious Area in the Nation for Medicare Fraud

  In this story, local agencies take action against growing Medicare fraud affecting families, children and the elderly in South Texas. FROM FOX RIO GRANDE VALLEY: According to the US Government, South Texas is the second most notorious area in the nation for medicare fraud. Today different agencies took action here in the valley. Since the day someone stole her credit card information. Dawn Grun says she knows she has to be very careful… Read the full story here.

Huff Post Business: Health Care Fraud Investigations Pulling In $8 for Every Dollar Spent

  Earlier this month, the departments of Justice and Health and Human services announced they recovered nearly $8 for every dollar invested in anti-fraud efforts in 2012. FROM HUFFINGTONPOST.COM: In particular, the hospital disclosed that it admitted patients for short stays – typically one or two days – that were not warranted by the patient’s medical condition, and thereby generated a larger reimbursement than was proper for each patient.   Of the $4.9 million to be paid by St. Joseph’s, $4.6 […]

U.S. Department of Justice: Maryland Hospital Agrees to Pay $4.9M for Medically Unnecessary Hospital Admissions

  The Justice Department reports that a Towson, MD, hospital will pay $4.9M for false claims to Medicare, Medicaid and other federal healthcare programs. FROM THE U.S. DEPARTMENT OF JUSTICE: In particular, the hospital disclosed that it admitted patients for short stays – typically one or two days – that were not warranted by the patient’s medical condition, and thereby generated a larger reimbursement than was proper for each patient.   Of the $4.9 million to be paid by St. Joseph’s, […]

Fox Business News: How big is Medicare fraud?

  In this story, Fox News discusses the rate of healthcare fraud and the impact on government retirement programs. FROM FOX BUSINESS NEWS: How big a retirement planning problem is Medicare fraud? In a May 2012 report, FBI Special Agent David Welker said, “The United States spends more than $2.5 trillion on health care annually, and rough estimates indicate that anywhere from 3% to 10% of all health care expenditures are attributed to fraud.” If you do Welker’s math, the […]

CBS News: The SCOOTER store power wheelchair company raided in federal probe

  As part of ongoing coverage of healthcare fraud, CBS News delves into the case of The SCOOTER Store, a power wheelchair company that overbilled Medicare by $108 million. FROM CBS NEWS: The issue is that once a doctor has written a prescription, Medicare rarely verifies whether the chairs are actually necessary. The problem was crystallized when the Inspector General of the Department of Health and Human Services released this report, finding that industry-wide, 80 percent of Medicare payments for power […]

Coalition Launches New Website

  The American Coalition for Healthcare Claims Integrity (ACHCI) today announced the launch of a new website, ProperPayments.org, that highlights the ongoing work of government accountability programs and private sector partners in the fight against waste, fraud and abuse in the nation’s healthcare system. Founded in 2009, the American Coalition for Healthcare Claims Integrity (ACHCI) is a non-profit organization committed to achieving 100% accuracy in payment claims submitted to public and private sector healthcare payors. The coalition’s mission is to educate […]

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FBI Uncovers $8.5M Medicare Fraud Scheme in Manhattan

  From the FBI website: Manhattan Doctor Pleads Guilty to $8.5 Million Medicare Fraud Scheme  Preet Bharara, the United States Attorney for the Southern District of New York, announced that Dr. Roberto Aymat, a medical doctor, pled guilty today in Manhattan federal court to participating in a scheme to defraud Medicare out of approximately $8.5 million through the use of fraudulent HIV/AIDS clinics in New York. As part of the scheme, Aymat and others billed Medicare for medications that were […]

’60 Minutes’ Tackles Hospital Fraud

Recently, 60 Minutes investigated Health Management Associates, the fourth largest for-profit hospital chain in the country. An estimated $210 billion a year goes toward unnecessary tests and treatments, with a large chunk of those tests being billed to Medicare and Medicaid programs. Watch the story to learn more about widespread fraud in the system.