Tuesday, July 28, 2015

Medicare Fraud is a Never Ending Story

A most Sad issue since it is many of those in the Medical Industry that are doing it. By their fraudulent actions, many are being denied the medical care they need and/or the government debt is being increased. (Debt in America: Real Time)

Here are just a few for July 27, 2015

A Public Awareness Issue shared
by the National Family Advocacy Team.

OIG posts two reports and enforcement actions
07/27/2015
OIG.HHS.GOV
Today, OIG posts two reports and enforcement actions. As always, you can use the links provided to go directly to the new material.
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Reports

Medicare Contractors' Payments to Providers for Hospital Outpatient Dental Services in Jurisdiction K Did Not Comply With Medicare Requirements (A-06-14-00022) http://go.usa.gov/37peH
Medicare contractor payments to providers in Jurisdiction K (Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, and Vermont) for hospital outpatient dental services did not comply with Medicare requirements. Of the 100 dental services in our stratified random sample, 85 did not comply with Medicare requirements. Using our sample results, we estimated that Medicare contractors improperly paid providers at least $2,276,853 for dental services provided during the period January 1, 2011, through December 31, 2013.
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Hospice of New York, LLC, Improperly Claimed Medicare Reimbursement for Some Hospice Services (A-02-13-01001) http://go.usa.gov/37peV
Hospice of New York, LLC (the Hospice), operating in New York State, claimed Medicare reimbursement for some hospice services that did not comply with certain Medicare requirements. Of the 100 beneficiary-months in our random sample for which the Hospice claimed Medicare reimbursement, 79 beneficiary-months complied with Medicare requirements, but 21 did not. We estimated that the Hospice received at least $1.3 million in improper Medicare reimbursement.

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Enforcement Actions

  • Owner of Detroit Home Health Care Companies Sentenced to 80 Months in Prison for Role in $12.6 Million Fraud Scheme (July 24, 2015; U.S. Department of Justice) http://go.usa.gov/3wjCE
  • Stockton Oncologist Pays $736,000 to Resolve False Claims Act Allegations (July 24, 2015; U.S. Attorney; Eastern District of California) http://go.usa.gov/3wjCE
  • Board Certified Obstetrician And Gynecologist Agrees To Civil Fraud Settlement In Conjunction With Deferred Prosecution In Medicare And Medicaid Fraud Investigation (July 24, 2015; U.S. Attorney; Eastern District of New York) http://go.usa.gov/3wjCE
  • Dallas County Woman Admits Defrauding Medicaid (July 24, 2015; U.S. Attorney; Northern District of Texas) http://go.usa.gov/3wjCE
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