Is Medicaid really broke? If not, who is making money where Managed Care is involved? According to this, not the providers. Is this ignored so that attention is focused on allegations of fraud by providers?
April 14, 2012 by Jerri Lynn Ward, J.D.
Filed under Business, Fraud, General Counsel, Home Health, Hospice, Hospitals, Licensed Health Providers, Medicaid, Medicare, Nursing Homes, Operational Issues, Patient Protection and Affordable Care Act, Physicans
On March 5, 2005, the Office of the Inspector General (“OIG”) launched its Compliance 101 website. The website contains links to guidance and educational training materials for health care providers, practitioners and suppliers. The site contains segment-specific compliance guidance for nursing facilities, ambulance suppliers, physician practices, etc. Although the materials are from 1998-2008, the compliance program guidance [...]
According to the Houston Chronicle, there’s a federal Medicare fraud strike force on the loose in Texas. The article highlights a number of Houston-area clinics committing Medicare fraud. Medicare fraud in the U.S. last year totaled $2.35 billion. There were 575 health fraud criminal actions and 342 civil actions filed. The task force has reduced [...]
The recent decision in United States v. Regence Blue Cross (10th Cir 12/05/2006) illustrates the power of qui tam, or private, civil lawsuits under the False Claims Act (FCA). Under the FCA, an action can be commenced either by the United States itself, or as a â€œqui tamâ€ action, by a private person acting â€œfor [...]
For an example of how whistleblowers and the False Claims Act interact, read this article, Home Health Care Industry Reels from Medicare Scandal. Whistleblowers can bring qui tam lawsuits against providers and benefit hugely. In this particular case, the whistleblower benefits as follows: The False Claims Act permits individuals to file qui tam lawsuits against [...]