On the FBI’s Medicare Fraud Strike Forces

4 Responses

1. Ann Miller RN MHA, on June 18, 2015 at 11:25 PM said:

   National Medicare Fraud Takedown Results in Charges Against 243 Individuals
   

   Attorney General Loretta E. Lynch and Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell announced today a nationwide sweep led by the Medicare Fraud Strike Force in 17 districts, resulting in charges against 243 individuals, including 46 doctors, nurses, and other licensed medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $712 million in false billings.

   In addition, the Centers for Medicare & Medicaid Services (CMS) also suspended a number of providers using its suspension authority as provided in the Affordable Care Act. This coordinated takedown is the largest in Strike Force history, both in terms of the number of defendants charged and loss amount.

   Source: OIG [6/18/15]

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2. Pamela, on July 23, 2015 at 12:33 PM said:

   Medicare Sends Payments to Doctors Who Don’t Exist?

   Nearly $60 billion in Medicare funds distributed in 2014 that were meant to reimburse doctors for the care they gave older Americans were doled out to practices with dubious addresses or delivered to medical providers who had been given disciplinary actions by professional boards, according to the federal government’s watchdog agency.

   http://www.msn.com/en-us/money/markets/medicare-sends-payments-to-doctors-who-don%e2%80%99t-exist/ar-AAdlMJP?ocid=iehp

   Pamela

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3. Ann Miller RN MHA,, on December 9, 2015 at 11:51 AM said:

   Supreme Court to Rule on Theory Underlying Many Healthcare Fraud Suits

   A case now before the U.S. Supreme Court could mean fewer fraud lawsuits filed against healthcare providers. Or it could at least give them more clarity about what constitutes a violation of the law, experts say.

   The Supreme Court just announced it would hear Universal Health Services v. United States ex rel Escobar, a case that focuses on one theory whistle-blowers and the government use in bringing False Claims Act cases to court. The act makes it illegal to knowingly submit fraudulent bills to the government, such as for services not actually performed.

   In a variation of fraud claims, some whistle-blowers allege that providers submitted false claims by failing to follow certain regulations. Providers sometimes are held liable for not following such regulations even if the government never explicitly stated that following a regulation was a condition of payment, and even if the provider never explicitly vouched that it had complied with the regulation. The Supreme Court will consider whether whistle-blowers and the government should be allowed to bring FCA cases under this theory, known as implied certification.

   Source: Lisa Schencker, Modern Healthcare [12/8/15]

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4. Dr. David Marcinko MBA, on September 29, 2016 at 11:24 PM said:

   New Fingerprinting Requirements for Medicare Enrollment

   In accordance with the Patient Protection and Affordable Care Act, Section 6401 and 42 CFR Section 424.518(c)(2)(B), (308 KB) all new and existing providers must be re-evaluated under the new screening guidelines. Part of these new screening guidelines is a requirement to fingerprint certain individuals identified in the enrollment records.

   Provider and suppliers receiving a request from Medicare must comply within 30 days from the date of the notice by following the instructions in the letter. Failure to submit fingerprints for all individuals listed within the designated time frame may result in revocation of your Medicare billing privileges.

   The following individuals may be asked to comply with the fingerprint requirement (not an all-inclusive list). Individuals who:

   • maintain a five percent or greater direct or indirect ownership interest in the provider or supplier of a HHA or DMEPOS
   • have had a payment suspension at any time in the last 10 years
   • have been excluded from Medicare by the OIG
   • have had billing privileges revoked by a Medicare contractor within the previous 10 years
   • have been terminated or are otherwise precluded from billing Medicaid
   • have been excluded from any federal healthcare program
   • have been subject to any final adverse action within the previous 10 years

   Source: CMS News [9/23/16] via Dr. Joseph Borreggine and PMNews #5,765

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