The Department of Justice recently announced that Genesis Healthcare Inc. will pay $53.6 million to resolve A allegations that it and its subsidiaries submitted false claims to government healthcare programs forA medically unnecessary therapy and hospice services, and grossly substandard nursing care. The case was brought by 7 whistleblowers who brought 6 separate federal lawsuits in the […]

The post Genesis Healthcare Inc. Agrees to Resolve Whistleblower Case for $53.6 Million appeared first on Medicare Fraud 101.

Prestige Administrative Services, LLC d/b/a Prestige Healthcare (Prestige), headquartered in Louisville, Kentucky has agreed to pay the United States to resolve genetic testing fraud allegations that it violated the False Claims Act. The Medicare false billing allegations involvedA unnecessary and fraudulent genetic testing.A Prestige is an owner/operator of nursing homes in several states, including four facilities […]

The post Prestige Healthcare Pays Government for its False Billing Role in Genetic Testing Fraud appeared first on Medicare Fraud 101.

Recently, the Department of Justice announced that TeamHealth Holdings (successor in interest to IPC Healthcare Inc.) has agreed to pay $60 million to resolve upcoding allegations by billing Medicare, Medicaid, the Defense Health Agency and the Federal Employees Health Benefits Program for higher and more expensive levels of medical service than were actually performed.A The […]

The post Hospital Service Provider Pays $60 Million to Settle Healthcare Fraud Allegations appeared first on Medicare Fraud 101.

“Ambulance service companies should be focused on the needs of the patients,a said HHS OfficeA of Inspector General Special Agent in Charge Phillip Coyne. He continued: Billing Medicare for ambulance rides thatA were unnecessary or at a higher rate than could be medically justified is unacceptable. Together withA our law enforcement partners, we will seek out and stop […]

The post Medicare Dollars Are Still Siphoned Through Ambulance Fraud appeared first on Medicare Fraud 101.

Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Departmentas Civil Division, announced recently that the Department of Justice obtained more than $4.7 billion in settlements and judgments from civil cases involving fraudulent claims against the government in fiscal year 2016. This is the third highest annual recovery in False Claims Act history, […]

The post Civil Health Care Fraud Recoveries Have Exceeded $2 billion for the Seventh Consecutive Year appeared first on Medicare Fraud 101.

The vast majority of False Claims Act settlements involving kickback allegations have been instances where healthcare providers have allegedly received kickbacks for utilizing a manufactureras product. Recently, however, there have been a few successful recoveries where the alleged kickback recipient was not the ultimate decision-maker or even healthcare provider. While this is an expansion of […]

The post Anti-Kickback Statute Reaches Consultants Who Seek to Improperly Influence Healthcare Providers appeared first on Medicare Fraud 101.

Recently, the Justice Department announced a first-of-its-kind settlement involving allegations that a health system violated the False Claims Act by retaining Medicaid overpayments for more than 60 days after identifying that overpayments were made. This $2.95 million settlement with Mount Sinai Health System was the first settlement involving the Affordable Care Act provision that created […]

The post Government Recovers Millions from Hospital System that Allegedly Wrongfully Retained Medicaid Overpayments for Over 60 Days appeared first on Medicare Fraud 101.

In a recent Wall Street Journal article titled, aIn-Office Testing by Doctors Lifts Medicare Costs,a it was revealed that a sizeable chunk of the Medicare dollars are now going to physicians who utilize newly minted in-office medical devices. In fact, the WSJas analysis of recently released Medicare billing data showed that four of the top […]

The post Are Medically Unnecessary Tests Driving Growth of In-Office Procedures? appeared first on Medicare Fraud 101.

In recent years, the federal government has reviewed the issue of copayment assistance organizations that purport to help Medicare and Medicaid beneficiaries with their pharmaceutical copayments, but has not yet taken any public enforcement action to our knowledge. Now, the media seems to be taking a closer look, as seen in a recent Bloomberg article […]

The post Are Copayment Assistance Nonprofits to Funneling Kickbacks to Patients? appeared first on Medicare Fraud 101.

Over the last few years, the government has devoted substantial resources to pursue hospitals that inappropriately admit patients to inpatient stays. This month, the government intervened after initial declaration in a qui tam case against 14-hospital health system Prime Healthcare. The lawsuit included allegations that senior management would: criticize Emergency Department doctors and demand their […]

The post Are Hospitals Pressuring ER Physicians to Inappropriately Admit Patients? appeared first on Medicare Fraud 101.