Articles Tagged with healthcare fraud. Medicaid fraud

IMG_0209-300x200A whistleblower in Oklahoma, Jennifferr Baird, filed a complaint against the hospital she worked at as a registered nurse for fraudulent Medicaid billing practices. Following the filing, Oklahoma Heart Hospital agreed to settle the allegations with a $2.8 million fee.

Baird was in charge of a team of seven staff members and alleged that for at least seven years the hospital consistently billed Medicaid at inpatient rates, even if the patient was being treated as an outpatient.

“First, OHH routes almost all of its Medicaid patients to inpatient treatment, when many should be classified as outpatient; in doing so OHH is able to charge significantly larger fees for the same treatment. The fraud is evidenced by the fact that OHH does not treat its Medicare or privately insured patients similarly.”, the lawsuit stated.

Thousands of doctors and other medical professionals are billing Medicare for increasingly complicated and costly treatments and this signals a rise in Medicare billing abuse. This is according to an investigation by the Center for Public Integrity which shows that between 2001 and 2010 doctors moved to higher paying codes for billing Medicare for office visits while cutting back on lower paying ones. The organization also found no increase in the average age of patients and the data do not indicate that patients are more infirm as a reason for the increase. This suggests that the shift to higher codes is a result of “upcoding” also known as “code creep” a form of bill padding in which doctors bill Medicare for more expensive services than were actually delivered. Doctors, hospitals and many other providers are paid by medicare based on a series of billing codes. Medicare, covering 49 million elderly Americans spent more than $500 billion in 2011. in a report in May 2012, the Department of Health and Human Services inspector general said that the coding system is vulnerable to fraud and abuse and that it is impossible to determine the precise extent of the problem without looking at the records for each of the 370 million claims Medicare pays annually.