Fraud (Medicare) « Medicare
Resources and Articles
About Medicare Fraud
- Medicare.gov – Medicare Fraud Overview
Information on fraud detection/prevention, how to report fraud and helpful publications.
- Medicare Fraud & Abuse: Prevention, Detection, and Reporting (Dept. of Health and Human Services)
Medicare fraud and abuse is a serious problem requiring your attention. Although there is no precise measure of health care fraud and the majority of health care providers are honest and well-intentioned, a minority of providers who are intent on abusing the system can cost taxpayers billions of dollars and put beneficiaries’ health and welfare at risk. The impact of these losses and risks is magnified by the growing number of people served by Medicare and the increased strain on Federal and state budgets
- National Health Care Anti-Fraud Association
- US Department of Health & Human Services – Report Fraud
- US Department of Health & Human Services and U.S. Dept. of Justice – Stop Medicare Fraud
Articles About Medicare Fraud
- Corporate Whistleblower Center Says Medicare/Medicaid Fraud Out of Control (PR Web – 1/11/08)
Americas Watchdog's Corporate Whistleblower Center is releasing its annual report on Medicare & Medicaid fraud, and according to the group things have never been worse. The report focuses on nursing homes, drug/medical device companies, not for profit, and boutique hospitals. The group referred to its findings as grim with respect to Medicare and Medicaid over billing & fraud.
- Healthcare Fraud 101: How to Report Medicare or Medicaid Fraud (Examiner.com – 8/21/09)
This article takes a brief look at some of the state and federal agencies that deal with such civil or criminal violations.
- Home Health Agency Owners Charged with Medicare Fraud (Crain's Detroit – 12/19/08)
Owners and employees of eight home health agencies in Southeast Michigan were indicted by a federal grand jury in Detroit on charges they were part of a scheme to pay kickbacks in exchange for Medicare patient referrals.
- Medicare Fraud Effort Gives Elderly Surprise Hospital Bills (Bloomberg – 7/12/10)
Larry Barrows, 76, spent eight days in a Canton, Connecticut, hospital after falling twice in a day. Despite being covered by Medicare, the federal health plan for the elderly, Barrows was hit with $36,000 in normally reimbursed bills because of an unintended glitch in U.S. rules. John Dempsey Hospital said Barrows was under “observation” during his stay, said his wife, Lee. Under Medicare rules, patients listed as under observation face 20 percent co-payments that wouldn’t be required if they were admitted, and expensive aftercare isn’t covered at all. Larry Barrows needed three months of rehabilitation that Medicare wouldn’t pay for because the hospital didn’t call him an inpatient, something his family didn’t learn until halfway through his hospital stay, said his wife.
- Medicare Fraud Strike Force Charges 91 Individuals for Approximately $430 Million in False Billing (HHS.gov – 10/4/12)
“Today’s arrests put criminals on notice that we are cracking down hard on people who want to steal from Medicare,” said HHS Secretary Sebelius. “The health care law gives us new tools to better fight fraud and make Medicare stronger. In addition to the arrests made today, HHS used new authority from the health care law to stop future payments to many of the health care providers suspected of fraud, saving Medicare resources and taxpayer dollars from being lost to fraud in the first place.”
- Medicare Scam Alert
Kentucky Attorney General Jack Conway’s office reports that senior’s in Kentucky and other states are receiving “fraudulent phone calls asking for personal information so that new Medicare cards may be issued to the consumers.”
- Pfizer Fined $2.3 Billion to Settle Medicare and Medicaid Fraud Case (Examinar.com – 9/2/09)
The largest fine ever levied for fraud in the Medicare and Medicaid programs. Charges of fraud in marketing are becoming common against pharmaceutical companies. Almost every major drug manufacturer has been accused by the Justice Department of giving kick backs to doctors or changing Medicaid improper rates.
- Whistle-Blower 'Blown Away' by DOJ Reward Stance (ABA Journal – Oct. 25, 2007)
Cell Therapeutics has agreed to settle a whistle-blower suit that contended the company marketed a cancer drug for unapproved uses, costing Medicare millions of dollars. But the whistle-blower could get nothing.