On June 18, 2015, the US Attorney announced two investigations resulting in a number of accusations of Medicare and Medicaid fraud and abuse. The “Home Alone IV” take-down and the largest national health care fraud take-down to date involving more than 200 subjects accused of defrauding Medicare and Medicaid of more than $700 Million in 14 states. Each of these takedown operations demonstrate just how seriously the Health Care Fraud Prevention and Enforcement Action Team (HEAT) is in its efforts to reduce fraud and abuse in healthcare operations.
We provide insights and analysis for physicians, nurses, chiropractors, dentists, physical therapists and other health professionals on issues impacting their practices.
Summer’s almost here and the weather is heating up for HEAT, the Department of Justice’s (DOJ) task force to combat healthcare fraud. This whistleblower initiated action was brought to the attention of the government by a former pharmacist employed by PharMerica. The settlement announced today relates to allegations of dispensing Schedule II controlled drugs without a valid prescription resulting in violation of the False Claims Act for submitting false claims to Medicare for the improperly dispensed drugs.
False Claims Act Update - 16 Hospitals to Pay $15.69M Related to Medically Unnecessary Psychotherapy Services
On May 7, 2015, the Department of Justice reported settlement with 16 separate hospitals for medically unnecessary or unreasonable psychotherapy services. The claims under scrutiny were Intensive Outpatient Psychotherapy (IOP) services, which represent a variety of treatment methods. The services, while billed to Medicare by the providers, were performed on the providers’ behalf by Allegiance health Management, a post-acute healthcare management company.
Fraud and Abuse in healthcare remains a hot issue, as evidenced by recent HEAT announcements. Following three qui tam (whistleblower) actions being filed, the Department of Justice announced it would intervene in the consolidated lawsuits. At issue was whether HCR Manorcare exerted pressure on SNF administrators and rehabilitation therapists to provide medically unnecessary and unreasonable services by administering additional treatments to qualify for the highest Medicare payments. Allegations also claimed HCR Manorcare kept patients in its facilities even though they were medically ready for discharge.
Hot Day for HEAT - Medicare Fraud Strike Force Announces 1 Conviction, 1 Guilty Plea & 1 Indictment Today
On April 17, 2015, the Health Care Fraud Prevention and Enforcement Action Team (HEAT) reported three new actions involving Medicare fraud and abuse. Since the Medicare Fraud Strike Force began in March 2007, HEAT has charged nearly 2,100 defendants who have collectively billed the Medicare program for more than $6.5B.