fraud

CMS reports lower error rate for 2008

Anne Zieger — Tue, 18 Nov 2008 09:05:34 -0500

Apparently, having Recovery Audit Contractors in the news frequently has pushed some providers to change their coding practices. CMS has reported that the 2008 error rate for fee-for-service payments has decreased to 3.6 percent. Last year, improper payments for fee-for-service amounted to 3.9 percent of the total payments.

The CMS estimates that it has saved as much as $400 million over the last fiscal year. The agency also reported for the first time the improper payment rate of Medicare Advantage; in 2006, it reported the improper payments amounted to 10.6 percent, or $6.8 billion. The CMS also made clear that most of these errors are from incorrectly coded or medically unnecessary claims, not actual fraud.

To learn more about the figures CMS released:
- read this Modern Healthcare piece (reg. req.)

Duke University Health sued over dirty surgical instruments

Anne Zieger — Wed, 02 Jul 2008 11:32:45 -0400

A group of 18 patients who had operations at Duke University Health System hospitals in 2004 have sued the institution, which exposed the patients to surgical instruments that were mistakenly washed in elevator hydraulic fluid. The suit, which charges the institution with fraud and negligence, asks for an unspecified dollar amount in compensatory and punitive damages. Duke has already settled claims with more than 60 other patients who claimed they had been injured by the hydraulic fluid. This new group of patients claim they have suffered injuries and pain following varied surgeries. They also contend that Duke committed fraud by concealing some facts and misrepresenting others in ways that made it harder for patients and their physicians to deal with the effects of the injuries.

The plaintiffs are only a small fraction of the 3,600 patients of Durham Regional or Duke Raleigh who were operated on with the unsanitary tools in late 2004. The tools became tainted due to a series of errors in which repairmen drained elevator fluid into empty detergent drums that were mistakenly shipped back to the hospitals as washing fluid.

To learn more about the case:
- read this article from The News & Observer

HHS wants more detail in fraud self-disclosures

Wed, 16 Apr 2008 06:59:58 -0400

Since 1998, providers who voluntarily reported fraud to the HHS inspector general's office have been given leniency in their treatment. However, HHS now has changed the rules governing this policy. Under the new rules, providers will now have to provide a better explanation of what's being disclosed if they want gentler treatment. Providers will now have to offer a complete description of the questionable conduct, name which laws may have been violated, provide the results of an internal investigation, and offer an estimate of damages and the method used to determine them. (If the last two aren't available, providers are allowed to provide them later, as long as they wait no longer than three months.) If providers meet all of these requirements, and cooperate with the HHS IG, they can potentially walk away without having to sign a corporate integrity agreement, HHS officials said.

To learn more about these changes in fraud self-disclosure rules:
- read this Modern Healthcare article (reg. req.)

FL doctor pays $7M to settle federal fraud suit

Wed, 16 Apr 2008 06:59:55 -0400

A physician who owns a Boca Raton, FL-based chain of medical imaging centers has agreed to pay $7 million to settle charges that he overcharged Medicare for services and ordered unnecessary tests. According to the settlement, radiologist Dr. Fred Steinberg overcharged Medicare for CT scans. The suit also charged that Steinberg illegally paid several local doctors to send him patients for imaging tests. Furthermore, it contended that his organization, University MRI and Diagnostic Imaging Centers, gave deep equipment and service discounts to local doctors, while hiring others as paid "medical directors" without requiring them to do any work. In the settlement, University MRI denied wrongdoing and said it settled to end the litigation process.

To learn more about the suit:
- read this South Florida Sun Sentinel piece

Related Articles:
FL health system settles Medicare fraud charges
Medicare fraud costs CMS billions
Fraud riddles Florida medical device firms
NJ hospital to pay $7.5 million Medicare fraud settlement

Dental HMO leaks personal information to website

Thu, 27 Mar 2008 07:59:55 -0400

Here we go again! As reported by the Baltimore Sun, a CareFirst BlueCross BlueShield dental HMO accidentally leaked personal information--including Social Security numbers--of around 75,000 patients on a public website in February, failing to inform them of the gaffe for three weeks. While the company claims none of the information has been misused, it also has offered members 12 months of free credit monitoring, and information to contact credit bureaus for fraud alert purposes. Still, this is the second time in two months that this sort of thing has happened. What has to happen for these sorts of mistakes to cease?

For more information:
- read the Baltimore Sun's article

Yale-New Haven settles Medicare charges

Mon, 10 Mar 2008 07:59:54 -0400

Yale-New Haven Hospital has agreed to pay the federal government $3.77 million to settle accusations that it had inflated its Medicare charges. According to the U.S. Attorney, Yale-New Haven billed Medicare for multiple units of infusion therapy, blood transfusion and chemotherapy per patient visit, despite the fact that Medicare only allows payment for one unit of these therapies per visit. The government also argued that the hospital hadn't documented claims for oncology infusion services adequately. In this case, no whistleblower was involved; the charges came to light when the hospital disclosed them voluntarily.

To learn more about the settlement:
- read this Associated Press piece

Related Articles:
NJ hospital to pay $7.5M Medicare fraud settlement. Report
Caremark to pay $38.5M settlement. Report
NJ hospitals face false-claims charges. Report
St. Barnabas to pay $265 million for Medicare fraud. Report

FL surgeon refuses to give up license

Fri, 08 Feb 2008 06:59:55 -0500

Miami heart surgeon Alex Zakharia had resolved his legal troubles, or so it appeared. Dr. Zakharia, who was accused of fraud and perjury, pled guilty last fall to a misdemeanor which would spare him jail time. In return, he agreed to retire and surrender his Florida medical license by December 31, 2007. Aside from avoiding jail, the plea seemed prudent given a neurologist's letter filed with the court indicating that he was suffering increasingly frequent memory lapses. Now, according to reports, it appears Dr. Zakharia is still practicing medicine. With the doctor scheduled to be sentenced in Detroit federal court, the prosecutor there says Zakharia's lawyer has told him that Zakharia has decided not to comply with the agreement.

The 70-year-old physician was suspended in November 2006 by Miami-based Cedars Medical Center following the deaths of several of his patients, according to court documents there. That same month, he was indicted by the U.S. Attorney's Office in Detroit on fraud and false declaration charges resulting from a deposition he gave in the case of a man suing the Veteran's Administration. Since then, Dr. Zakharia has countersued Cedars, accusing the hospital of malice and bad faith.

To learn more about the dispute:
- read this article in The Miami Herald

ALSO NOTED: Health finance execs stand trial for $1.9B fraud; Wal-Mart, partners pilot personal health records; and much more..

Thu, 31 Jan 2008 06:59:50 -0500

> Six years after its collapse, executives from what was one of the country's biggest health care finance companies are standing trial for an alleged $1.9 billion fraud. Article

> More than year after its launch, Wal-Mart and other corporate giants have launched a pilot test of their employee personal health record, Dossia. FierceHealthIT

> Research increasingly suggests that Iraq war veterans with brain injuries aren't getting adequate care. Article

> To foster the adoption of personal health records, the industry will need to come up with uniform standards for verifying patient IDs. FierceHealthIT

And Finally... Don't watch the Super Bowl if you have a weak heart, researchers say. Article

MDs, others face charges on Net pharmacy operation

Mon, 06 Aug 2007 06:59:56 -0400

A federal grand jury in San Diego has indicted 18 people on charges arising from a large-scale Internet pharmacy operation. The grand jury charged these individuals with racketeering, fraud and money laundering charges. It marks the first time racketeering charges have been filed in connection with an Internet pharmacy case.

According to the indictments, the pharmacy business, Affpower, sold about 700,000 prescriptions to customers using illegal prescriptions. The company generated $126 million in revenues during a two-year period ending in June 2006, according to a federal official involved with the case.

The indictment, which included 313 counts, included three doctors and two pharmacists from among the pool of defendants. The doctors' job was to give a quick look to online questionnaires filled out by Web site visitors, then approve and write prescriptions. The physicians got $3 for every form they reviewed.

To learn more about the charges:
- read this piece in the San Diego Union Tribune

Related Articles:
St. Barnabas racketeering suit dismissed. Report
NY hospitals sue UnitedHealth, claim racketeering. Report
UConn Health Center settles Medicare charges. Report
Pediatrix settles over-billing claim for $25M. Report

Tennessee educates MDs on drug-fraud law

Fri, 27 Jul 2007 06:59:54 -0400

Tennessee's Office of the Inspector General wants to be sure medical professionals know about new legislation designed to reduce TennCare drug fraud. So the state OIG just sent out letters to more than 30,000 doctors, pharmacists and nurses educating them on the details of a new law designed to cut down on patient "doctor shopping" (visiting multiple doctors to get similar or the same medications from each). The state's OIG was created three years ago specifically to root out and prosecute fraud against TennCare. Since its inception in February 2005, the office has arrested 460 individuals for TennCare fraud, has collected more than $700,000 in restitution, and avoided more than $75 million in costs.

To learn more about the new law:
- read this Memphis Business Journal item

Related Articles:
Doctor sues Ct. after Medicaid fraud allegation. Report
SPOTLIGHT: Watch out for Medicaid whistleblowers. Report
SPOTLIGHT: New York Medicaid program under fire. Report