Medicare Fraud Guilty Plea in $100 Million scheme

We’ve talked about Medicaid and Medicare fraud by way of “ghost patients.”  Medical providers bill Medicare or Medicaid for patients who do not exist or who didn’t receive the billed health care.  Now we’re moving on to “phantom clinics”. A man plead guilty on Friday to billing Medicare a whopping $100 million for health care clinics that did not exist.  Not only were the patients ghosts, but so were the doctors.  And there were at least 118 phantom clinics! If you have non-public information about Medicare fraud or other health care fraud, a...

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Medicare fraud whistleblowers to share in $5.25M

Medicare fraud whistleblowers will get a share of the $5.25 million settlement reached between the United States Department of Justice and a major pharmacy chain.  RxAmerica, a subsidiary of CVS Caremark, settled claims that it misrepresented the cost of prescription drugs to seniors under Medicare part D. Under the False Claims Act, a whistleblower receives a percentage of any monies recovered by the government.  The amount a whistleblower could receive ranges from 15 to 30 percent of the total monetary recovery by the government. If you have non-public information about Medicare fraud or...

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Abbott Labs Fined $700M for Off Label Marketing

For off label marketing of the drug Depakote, a federal district judge last week ordered Abbott Laboratories to pay a $500 Million criminal fine, to forfeit $198.5 Million, and to pay $1.5 Million to the Virginia Medicaid Fraud Control Unit. In May, Abbott Laboratories pled guilty to off-label marketing of Depakote for dementia and schizophrenia, uses not approved by the FDA.  It also settled allegations that it marketed Depakote for psychiatric illnesses in children, including conduct disorders, attention deficit disorder and autism, and other psychiatric illnesses in adults, including...

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Medicare Fraud Endangers Patient Health

Not only is Medicare fraud bankrupting the country, but it also endangers patients health.  NYTimes tells the story of a man who received the wrong motorized chair – a shoddier, more dangerous chair than the one he had ordered – due to fraud.  The Times explains the financial and health care costs: Medicare abuse and fraud like this costs taxpayers tens of billions of dollars every year. The Centers for Medicare and Medicaid Services, or C.M.S., estimated that in 2010, the two programs together made more than $65 billion in improper federal payments. An April 2012 study by a...

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Medicare Fraud Fought With New Tools

The Affordable Care Act, widely called “Obamacare,” provides new tools and funding for combatting Medicare fraud and Medicaid fraud.  The purpose is to reduce the costs of fraud to the government and taxpayers.  NPR explains: Medicare and Medicaid pay out some $750 billion each year to more than 1.5 million doctors, hospitals and medical suppliers. By many estimates, about $65 billion a year is lost to fraud…. Criminals use real patient IDs to bill for wheelchairs that were never delivered or exams never performed.  Dishonest doctors — a small percentage of physicians,...

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Whistleblower Reward of Nearly $21M for Health Plan Employee

  WellCare Health Plans employee blew the whistle on the managed care plan’s scheme to double bill Medicare and Medicaid for patient services.  The whistleblower was a senior financial analyst with WellCare, which provides managed care plans for 2.6 million people on Medicare and Medicaid.   The Tampa Bay Times explains the whistleblower reward:   Whistle-blowers who bring a lawsuit under the False Claims Act are entitled to receive a percentage of the recovery. Hellein’s award of $20.75 million represents his share of the $40 million in restitution received by the...

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