Author Archives: Site Administrator
Making Copays for Patients
We have blogged in the past about a common Medicare fraud scheme that involves waiving patient copayments and deductibles. The basic scheme works like this. Medicare normally requires that healthcare providers collect a copayment equal to 20% of the covered item or service. Crooked healthcare providers will waive or forgive this 20% copay as… Read More »
Medicare Paid $54 Million for Medically Unnecessary and “Mystery” Ambulance Rides
The U.S. Department of Health and Human Services Office of Inspector General (OIG) recently released a detailed study of ambulance transports billed to Medicare Part B in the first half of 2012 that identified millions of dollars of dubious and potentially fraudulent payments. Of the $2.86 billion paid by Medicare for ambulance services in… Read More »
Can Whistleblowers Bring Group Qui Tam Claims?
Yes, whistleblowers can bring group claims in qui tam cases. Indeed, this is a somewhat frequent occurrence and often is a successful strategy once the pros and cons are considered. What are the pros of bringing a group qui tam claim? A number of pros exist for bringing a group qui tam claim with… Read More »
Urine Drug Testing Laboratory Fraud
On October 19, 2015, the United States Department of Justice announced that Millennium Health, formerly Millennium Laboratories, had agreed to pay $256 million to resolve allegations of Medicare fraud in connection with urine drug testing and genetic testing. Millennium is a nationwide company engaged in the lucrative and highly competitive business of urine drug… Read More »
Reverse Mortgage Fraud & the False Claims Act
Reverse mortgage fraud is on the rise, and taxpayers are paying the bill. How? A reverse mortgage is a type of home equity loan available only to elderly borrowers who have a large amount of equity in their homes. Essentially, the borrower cashes out the equity by taking a loan, usually paid to the… Read More »
Waiver of Co-Payments & Deductibles
In most cases, Medicare does not pay for 100% of covered medical items or services. Most commonly, Medicare covers only 80%. The remaining 20% must be paid by the Medicare beneficiary as a form of co-insurance or co-payment. Medicare beneficiaries might have supplemental insurance policies that pay for part or all of this 20%… Read More »
Using Company Documents to Prove the Fraud
A recent case in Illinois highlights a common battleground in qui tam whistleblower cases namely, the whistleblower who keeps and relies upon company documents to prove the fraud allegations of his or her complaint. In Shmushkovich v. Home Bound Healthcare, Inc., 2015 WL 3896947 (N.D. Ill. June 23, 2015), a whistleblower brought a qui… Read More »
Compounded Pain Creams and Gels
As recently reported by CBS News, federal authorities are currently investigating widespread fraud occurring in the area of compounded pharmaceuticals and compounding pharmacies. Compounding refers to the process by which medications can be turned into topical creams, ointments and gels. Many pharmacies specialize in the manufacture of compounded medications, especially compounded pain and scar… Read More »
Whistleblowers and HIPAA
Whistleblowers often face a difficult decision when they suspect fraud at their place of employment. The whistleblower knows that fraud is being committed, but he or she will never be able to prove it without keeping or retaining documents and records that might be protected by the Health Insurance Portability and Accountability Act, more… Read More »
Contractor Settles Suit Related to Set Aside Contracts
According to the Department of Justice, LB&B Associates, Inc. (“LB&B”) has agreed to settle a qui tam lawsuit alleging it violated the False Claims Act by claiming it qualified as a Small Disadvantaged Business when it did not. LB&B is a North Carolina corporation that was formed in 1992 and is headquartered in Columbia,… Read More »