Providers Pay Millions to Resolve Medicare Fraud Cases
Several healthcare providers have recently settled Medicare fraud cases with the Department of Justice.
By - Healthcare fraud, abuse, and waste can cost the government millions, but recently, federal agencies have made catching and preventing Medicare fraud a top priority.
Last month, the Department of Justice partnered with the Department of Health and Human Services to charge over 300 individuals, including 61 physicians and licensed medical professionals, in the largest healthcare fraud takedown in its history. The defendants had allegedly participated in fraud schemes totaling $900 million in false medical billing.
Continuing its efforts to resolve improper payments, the Department of Justice has recently settled several healthcare fraud lawsuits involving Medicare.
California hospital agrees to pay $5.5 million in Medicare fraud case
A California-based medical center that reportedly participated in healthcare fraud schemes in 2012 has agreed to a $5.5 million settlement with the Attorney General’s office, according to a local news source.
Marshall Medical Center has been accused by Collen Herren, a former clinical nursing director for specialty clinics at the hospital, of improperly billing Medicare, particularly for cancer treatments. She has also reported that four other defendants defrauded insurance systems, including Marshall Foundation for Community Health, El Dorado Hematology and Medical Oncology, Lin H. Soe, MD, and Tsuong Tsai, MD.
In the suit filed by Herren, the defendants allegedly performed cancer treatments, such as chemotherapy and transfusions, without a physician present. The suit stated that the defendants still billed Medicare as if a doctor had been there for the services.
The suit also claimed that the medical center’s oncology nurses billed Medicare and Medicaid for two separate dosages of a medication for two patients despite giving patients a single-dose vial.
Herren stated that she had notified hospital management of the potential healthcare fraud, including lack of physician oversight, double billing for medications, and billing for provider visits that never occurred. However, she alleged that she was terminated from her job at Marshall Medical Center after alerting management, although the employment claims are part of a separate lawsuit.
Under the False Claims Act, she will receive 26 percent of the settlement, or $1.4 million, for her role as a whistleblower.
While the medical center has agreed to settle the case, it does not admit to committing medical billing fraud.
“Marshall has poured time and resources into battling the suit for the past four years and made a business decision to enter into a settlement so as to avoid the costs of a lengthy trial,” said Lourdes Edralin, Marshall Medical Center spokesperson. “It is important to note that neither the federal government nor the state intervened in this case, that these were allegations only and there was no finding or admission of liability or wrongdoing by Marshall.”
Medicare fraud lawsuit in Nevada ends in $9.5 million settlement
Renown Health has paid $9.5 million to the Department of Justice following a civil allegation from 2012 accusing the healthcare system of Medicare fraud, reported MyNews4.com.
A whistleblower had filed the lawsuit that claimed Renown Health had submitted false Medicare claims for services performed at two of its locations between June 2006 and June 2014. The healthcare system reportedly billed Medicare for inpatient hospital services, although the treatments should have been identified as less expensive outpatient or observation treatments.
The Office of the Inspector General investigated the accusations.
“The US Attorney's Office for the District of Nevada devotes significant resources in our civil and criminal divisions to health care fraud prevention and enforcement efforts,” said Daniel G. Bogden, US Attorney for the District of Nevada. “We are committed to cracking down on individuals and organizations which try to defraud Medicare.”
The healthcare system responded to the recent settlement by explaining that it had “technical billing issues surrounding types of patient care.”
“These types of lawsuits are becoming increasingly common nationwide,” a representative from Renown Health said. “After the federal government evaluated the case, they decided not to pursue any action. The plaintiff, however, decided to pursue the case on her own. After careful consideration we made a decision to settle the lawsuit rather than to pursue a lengthy and costly defense.”
Florida cardiologist faces $2 million settlement and Medicare exclusion
After being investigated for healthcare fraud, a Florida-based cardiologist, Asad Qamar, and his practice, the Institute of Cardiovascular Excellence, has agreed to pay $2 million and forfeit any claim to $5.3 million in suspended Medicare payments.
According to the Department of Justice’s press release, the cardiologist also cannot participate in federal healthcare programs, including Medicare, for a three-year period.
The settlement stems from two lawsuits claiming that Qamar and his practice had billed federal healthcare programs for medically unnecessary and inadequately documented services. The federal department stated that many of the billed services were not indicated by the patient’s healthcare record or history as well as the severity of the patient’s symptoms.
The cardiologist is also accused of paying kickbacks to patients by waiving the 20 percent Medicare copayment regardless of the patient’s financial status. Kickbacks induced patients to agree to medically unnecessary services, explained the lawsuit.
Due to these activities, Qamar became the highest paid Medicare cardiologist in the nation in 2012 and 2013, stated the press release.
“Billing federal health programs for medically unnecessary procedures is unacceptable – not only does it waste taxpayer funds, but it also puts patients at risk,” said Benjamin C. Mizer, Principal Deputy Assistant Attorney General and Head of the Justice Department’s Civil Division.
“Today’s settlement evidences the Department of Justice’s firm commitment to protect public funds and to safeguard the well-being of federal healthcare program beneficiaries.”
