Medicare Audit | The Health Law Firm Blog

Major Medicare Offender Sentenced to Prison for Multi-Million Dollar Health Care Fraud Scheme

By Lance O. Leider, J.D., The Health Law Firm

The former owner of four mental health facilities in South Florida and North Carolina was sentenced to fourteen (14) years in federal prison on February 25, 2013. The former business owner pleaded guilty to defrauding Medicare out of tens of millions of dollars from 2004 through 2011, according to the Department of Justice (DOJ). He had previously been convicted of cocaine trafficking but decided to move to Medicare fraud supposedly because he thought it would be safer. In total the former mental health facility owner was indicted for defrauding the government of nearly $63 million. As part of his plea, he […]

By The Health Law Firm|2024-03-14T10:00:45-04:00June 1, 2018|Assisted Living Facilities, In the News, Medicare, Medicare Audit, Medicare Fraud, The Health Law Firm Blog|

Occupational Therapists, Podiatrists, Psychologists and Optometrists Being Scrutinized in Medicare Audits

George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Our firm has recently seen an increase in the number of occupational therapists (OTs), speech therapists (STs), podiatrists, psychologists, optometrists and other licensed health professionals being scrutinized in Medicare audits and recovery actions. Often these result from claims submitted for evaluation or treatment entered in nursing homes or assisted living facilities (ALFs).

You Must Provide Complete and Detailed Documentation of Care Rendered.

In many cases, the provider may not have complete documentation of the care rendered because it has been placed in the patient’s record at the facility. Unfortunately, Medicare does not see this as an excuse […]

By The Health Law Firm|2024-03-14T10:00:45-04:00June 1, 2018|Assisted Living Facilities, Health Care Industry, Home health care facility, Medicare Audit, Medicare Fraud, The Health Law Firm Blog|

Government Discovers Extensive Overbilling of Cancer Drug to Medicare

By Lance O. Leider, J.D., The Health Law Firm, and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

It’s no surprise that the government is aggressively pursuing Medicare fraud. Recently, the Department of Health and Human Services (HHS), Office of Inspector General (OIG), made a surprising discovery. An audit uncovered that more than three-quarters (3/4) of all Medicare claims for the breast-cancer drug Herceptin were billed incorrectly, according to Modern Healthcare. This was found during an audit conducted on physicians and hospitals from around the country between January 1, 2008, and December 31, 2010.

To read the entire Modern Healthcare article, click […]

By The Health Law Firm|2024-03-14T10:00:44-04:00June 1, 2018|Medicare, Medicare Audit, Medicare Fraud, The Health Law Firm Blog|

New Hampshire City Auditing Ambulance Service for Allegedly Overbilling

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On July 16, 2012, a New Hampshire city allegedly launched an audit into its primary ambulance service, American Medical Response (AMR), after the company acknowledged overbilling hundreds of patients since 2011, according to a Union Leader article.

AMR Allegedly Incorrectly Billed More Than 300 Ambulance Trips.

According to the report, an in-house audit by the city showed that 323 ambulance trips out of nearly 5,000 in 2011 and 2012 had been incorrectly billed. This amounts to slightly more than six percent (6%). AMR attributes the overbilling to human error.

After concerns that the […]

By The Health Law Firm|2024-03-14T10:00:34-04:00June 1, 2018|Health Care Industry, In the News, Medicare, Medicare Audit, The Health Law Firm Blog|

Medicare Put the Hospice Industry Under the Microscope

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

It’s no surprise to anyone that Medicare is cracking down on hospices around the country. According to a report by the Office of Inspector General (OIG), eighty-two percent (82%) of hospices’ claims did not meet Medicare coverage requirements. That is why Medicare is investigating the industry as a whole. Specific details on what Medicare is looking for can be found in the 2013 OIG Work Plan. Click here to read the 2013 OIG Work Plan.

So far, Medicare has kept true to its word. During the week of […]

By The Health Law Firm|2024-03-14T10:00:44-04:00June 1, 2018|Health Care Industry, In the Know, In the News, Medicare, Medicare Audit, The Health Law Firm Blog|

Tennessee-Based Nursing Care Company Being Investigated for Medicare Fraud

By Danielle M. Murray, J.D.

The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) is investigating a Tennessee-based nursing care company. The company runs more than 200 skilled nursing homes (SNFs), assisted living facilities (ALFs), retirement living communities, home care services, and Alzheimer’s centers across the country. The nursing care company is accused of defrauding Medicare of millions of dollars for unnecessary and expensive therapy treatments from 2006 to 2011, according to the Wall Street Journal.

Click here to read the entire article from the Wall Street Journal.

Therapists Allegedly Encouraged to Perform Unnecessary and Costly […]

By The Health Law Firm|2024-03-14T10:00:42-04:00June 1, 2018|Assisted Living Facilities, Home health care facility, Medicare, Medicare Audit, Medicare Fraud, The Health Law Firm Blog, Whistleblower|

American Hospital Association (AHA) Sues U.S. Government for Denied Medicare Payments by RACs, ZPICs and Other Auditors

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On November 1, 2012, the American Hospital Association (AHA) filed a lawsuit against the U.S. Department of Health and Human Services (HHS) claiming that private auditors hired to crack down on improper Medicare payments are denying hospitals millions of dollars in medically necessary care, this is according to a number of sources. The AHA is seeking a court order declaring the practice invalid, saying it violates the Medicare Act.

Four hospital systems in Michigan, Missouri and Pennsylvania have joined the AHA as plaintiffs in the suit. The suit has been filed […]

By The Health Law Firm|2024-03-14T10:00:39-04:00June 1, 2018|Department of Health, In the Know, In the News, Medicare, Medicare Audit, The Health Law Firm Blog|

Revised Readmission Penalties are Coming Due to Calculation Errors

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Back in August of 2012, I wrote that lower Medicare reimbursement rates were coming to more than 2,000 hospitals around the country due to excessive readmission rates. To see that blog, click here.

In October of 2012, the Centers for Medicare and Medicaid Services (CMS) announced it has discovered errors in its initial calculations. This means, 1,422 hospitals with high readmission rates will lose slightly more money than first expected, according to Kaiser Health News.

Click here to read the entire article from Kaiser […]

By The Health Law Firm|2024-03-14T10:00:38-04:00June 1, 2018|In the Know, Medicare, Medicare Audit, The Health Law Firm Blog|

Phony Medical Equipment Supplier will Spend 30 months in Prison for Medicare Fraud

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A Los Angeles medical equipment supplier will spend 30 months in prison for submitting nearly $1 million in false claims to Medicare. The claims were almost all for expensive, high-end power wheelchairs. The man was sentenced on October 5, 2012.

To see the press release from the Department of Justice (DOJ), click here.

Man Owned and Operated a Phony Durable Medical Equipment Supply Company.

In February 2012, the defendant in this case pleaded guilty to owning and operating a fake durable medical equipment (DME) supply company, […]

By The Health Law Firm|2024-03-14T10:00:38-04:00June 1, 2018|Medicare, Medicare Audit, Medicare Fraud, The Health Law Firm Blog|

Ambulance Company in Tennessee Settles A $2 Million Overpayment Lawsuit

George F. Indest III, Board Certified by The Florida Bar in Health Law

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Dr. Thu Pham, O.D., Law Clerk, The Health Law Firm Attorney

A Tennessee ambulance company and the U.S. Department of Health and Human Services (DHHS) announced a settlement in a case over a post payment audit for more than two million dollars in May 2012. Back in March of 2010, the Nashville ambulance company sued the DHHS after being sent a $2.65 million overpayment demand, according to the Nashville Business Journal.

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By The Health Law Firm|2024-03-14T10:00:37-04:00June 1, 2018|Appeal, Medicare, Medicare Audit, The Health Law Firm Blog|