Qui Tam 101 » Medicare

New York City Home Health Agencies Pay $24 Million to Settle False Claims Act Claims

Nolan and Auerbach — Fri, 18 Dec 2009 03:26:57 +0000

The United States Department of Justice announced December 17, 2009 that the U.S. and state of New York have entered into settlement agreements with three home health agencies to resolve allegations that they submitted false claims to the New York Medicaid and Medicare programs.

The U.S. contends that Nursing Personnel Home Care knowingly supplied aides with phony training certificates to Extended Home Care and Excellent Home Care, which then billed New York Medicaid for the aides’ services. Allegedly, Extended Home Care and Excellent Home Care knowingly billed for aides with phony certificates who were untrained, and Extended Home Care and Excellent Home Care knowingly submitted claims to the Medicare program for home health aide services purportedly rendered by aides supplied by Nursing Personnel Home Care that were not actually provided.

The U.S. is receiving about $9.7 million as a result of the settlement with these three companies, and the state of New York is receiving about $14.3 million, for a total recovery of $24 million.

The allegations resolved by these settlements were initiated by two lawsuits filed under the whistleblower provisions of the False Claims Act.

For the full press release, go to: http://www.justice.gov/opa/pr/2009/December/09-civ-1362.html.

For more information about qui tam law and health care fraud, contact Nolan and Auerbach, PA.

Iowa Hospital to Pay U.S. $4.5 Million to Resolve False Claims Act Allegations

Nolan and Auerbach — Mon, 31 Aug 2009 15:19:43 +0000

Covenant Medical Center in Waterloo, Iowa has agreed to pay the United States $4.5 million to resolve allegations that it violated the False Claims Act, the Department of Justice announced today.

This settlement resolves allegations that Covenant submitted false claims to Medicare by having financial relationships with five physicians that violated the Stark Law. The United States alleged that Covenant violated the Stark Law by paying commercially unreasonable compensation, far above fair market value, to five employed physicians who referred their patients to Covenant for treatment. These physicians were among the highest paid hospital-employed physicians not just in Iowa, but in the entire United States, according to the DOJ.

For the full press release, go to: http://www.usdoj.gov/opa/pr/2009/August/09-civ-849.html.

For more information about qui tam law and health care fraud, contact Nolan and Auerbach, PA .

Dallas Hospital Reaches Settlement With the Government for Stark Violations

Nolan and Auerbach — Wed, 02 Jan 2008 15:29:55 +0000

According to the U.S. Attorney Richard B. Roper of the Northern District of Texas, Harris Methodist HEB Hospital, a 284 bed acute-care facility, will pay $1.9 million to settle allegations that it violated the False Claims Act by improperly submitting claims for payment for orthopedic-related items and services. These claims were identified as having taken place between March 15, 2004 and September 1, 2005.

According to the hospital in its own news release, the parent company of Harris Methodist HEB Hospital (Texas Health Resources) did a self report by telling the Office of Inspector General of Health and Human Services about it identification of a physician contract that did not comply with federal regulations. This triggered an investigation based on information provided by Harris Methodist HEB that Medicare and Texas Medicaid programs paid for orthopedic items and services referred to the hospital by a physician group that received free rent from the hospital, a violation of Stark self-referral law (also known as Physician Self-Referral Law).

The Stark law was created to forbid physicians from profiting from their own referrals. This law acts to sanction improper physician referrals and to stop the potential for over-utilization. In this fashion, physicians and other health care professionals are able to exercise independent judgment for what is in the best interests of their patients as opposed to themselves.

To read the full story click here or on the following to read more about the False Claims Act and the Stark Laws .

If you believe you have information concerning a violation of the False Claims Act and want to read more about Nolan & Auerbach, P.A. you may contact us.

Hospitals Are Giving Lessons on Blowing the Whistle on Fraud

Nolan and Auerbach — Thu, 27 Dec 2007 14:58:59 +0000

A federal law that takes effect in January 2007 requires the country’s hospitals and nursing homes to educate their employees and officers on how to detect and report fraud. This requirement applies to companies that earn at least $5 million a year in Medicaid business. Under the False Claims Act, whistleblowers have received millions of dollars for disclosing large-scale fraud.

To read more, click here.

U.S. Joins Suit Against Renal Care Group Alleging False Billings to Medicare for Home Care Renal Dialysis

Nolan and Auerbach — Tue, 28 Aug 2007 14:54:45 +0000

Last month, the United States intervened in a qui tam lawsuit accusing Renal Care Group Inc. (RCG) and Renal Care Group Supply Company (RCGSC) of fraudulently billing Medicare. The suit alleges that RCG and RCGSC fraudulently billed for supplies and equipment provided to End Stage Renal Disease (ESRD) patients who received dialysis treatments at home. Both companies are owned by Fresenius Medical Care Holdings Inc. which was also named in the lawsuit.

Feds Sue Nursing Home Company

Nolan and Auerbach — Mon, 25 Jun 2007 16:29:56 +0000

Cathedral Rock Corporation of Ft. Worth, Texas, which operates five nursing homes in St. Louis, Missouri has to now defend itself against a medicaid fraud lawsuit brought by federal authorities for violations of the False Claims Act. The lawsuit was brought by two whistleblower nurses who complained that patients were being neglected and that the facilities provided “worthless” health care.

To read more on this story click here.

Cost Report Fraud Allegations Cost Baptist Medical and Integris Health $12.2 Million

Nolan and Auerbach — Mon, 04 Dec 2006 15:30:12 +0000

A former contractor of Integris blew the whistle on Integris Health, Inc., alleging that it was submitting inflated claims to Medicare. The complaint stated that Integris sought payment from Medicare for post and non-transplant related costs that Integris knew were not reimbursable under the Medicare program. In addition,the Complaint alleged that Integris claimed Medicare reimbursement for liver and heart organ acquisition costs related to transplant patients who were not Medicare beneficiaries. The whistleblower will receive $2.3 million as a share of the recovery under the False Claims Act. Integris Baptist Medical Center, a not-for-profit health organization, is located in Oklahoma City, Oklahoma and operates the largest Medicare certified Heart, Liver and Kidney transplant program in the state of Texas. Integris Health, Inc. is the parent corporation for Integris Baptist Medical Center.

To read more on this article click here.

One of Nation’s Largest Ambulance Company Pays $9 Million for False Claims

Nolan and Auerbach — Tue, 10 Oct 2006 15:08:21 +0000

American Medical Response (AMR), based in Greenwood, Colorado and considered one of the largest U.S. ambulance providers has paid the United States over $9 million to resolve claims that the company violated the False Claims Act by providing illegal inducements to hospitals in Texas in exchange for referrals. These swapping arrangements gave the medical facilities discounts on transports in exchange for the referral of ambulance transports of patients being discharged from the hospitals, which were billed to Medicare. Two former employees of AMR blew the whistle and will each receive $1,620,000 as the result of the settlement.

For more information click here.

Guess What Else is NOT a Top Priority of the FDA?

Nolan and Auerbach — Wed, 12 Jul 2006 14:51:30 +0000

Answer: Monitoring postmarketing study commitments.

The FDA lacks an effective system for monitoring postmarketing study commitments. See the latest OIG Report, dated June 2006.

Stark Violations May Result in Exclusion of Tenet Hospital from Federal Programs

Nolan and Auerbach — Wed, 10 May 2006 16:34:44 +0000

The “Stark” statute, 42 U.S.C. §1395nn, is also known as the Physician Self-Referral Law or Section 1877 of the Social Security Act. The Stark law was intended to prevent physicians from profiting (actually or potentially) from their own referrals. The Stark statute acts prospectively, i.e., it prohibits relationships that have been demonstrated to encourage over-utilization. Because it is a strict liability statute, there is no need to show knowledge or intent.

Medicare and Medicaid programs depend on physicians and other health care professionals to exercise independent judgment in the best interests of patients. Financial incentives tied to referrals have a tendency to corrupt the healthcare delivery system in ways that harm the federal programs and their beneficiaries. Corruption of medical decision-making can result when a physician refers a patient to a provider on the basis of the physician’s financial self-interest instead of the patient’s best interests. Restrictions on the practice of self-referral exist at both the state and federal levels.

Medical directorships, interest free loans/forgiveness of debts, illegal recruitment arrangements and improper discounts in the form of professional courtesy, may represent additional financial windfalls to physicians, resulting in hospital referrals and a violation of the “Stark” statute. A Stark scenario may also be present when a hospital circumvents potentially compliant contracts by providing outside of what appear to be legitimate contracts, office space, renovations, equipment, furniture, housekeeping services, office supplies, copy and fax machines, telephone, utility and transcription services to referring physicians for free or less than fair market value.