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Hospitals to pay millions for alleged overbilling in Florida, Texas

  This week, authorities pursued two major cases of hospital fraud in Texas and Florida, respectively. In both cases, providers overbilled the government by millions. FROM FIERCE HEALTHCARE:  According to federal prosecutors, Driscoll Children’s Hospital-owned Children’s Physician Services of South Texas and Radiology Associates each billed the government for the same procedure over five years, resulting in at least $12.3 million in wrongful reimbursement, according to the report. (…) Meanwhile, a whistleblower lawsuit filed against Florida Hospital continues in federal court […]

CBS News: Medicare Fraud in Mobile

  In this investigation, Medicare scammers find new ways to target the elderly. FROM CBS NEWS MOBILE, AL: Medicare scams aren’t new. What is, is the scammer’s approach. Sandy Reynolds gets emails from the office of the Inspector General detailing different scams. “But it was last week when a lady called me and said that someone had called her on the phone and said that they wanted to replace her Medicare card,” says Reynolds, with the Area Agency on Aging. […]

South Florida Business Journal: Big prison sentences handed down for $48M home health Medicare fraud

  In this story, two Miami men are sentenced to prison in a multi-million dollar false Medicare claims case. FROM THE SOUTH FLORIDA BUSINESS JOURNAL: Florida is considered the worst state for questionable Medicare billings by home health agencies – a problem so severe that regulators are considering a moratorium on new home health agencies in the state. Rogelio Rodriguez was sentenced to nine years while Raymond Aday was sentenced to four years and three months in prison. They were […]

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 […]