Articles Tagged with Medicare

Medicare fraudFederal prosecutors say CityMD, a New York based urgent care, admitted that it overcharged Medicare. They will pay millions for ordering more expensive procedures, and billing for services provided by physicians who were not properly credentialed.

The Whistleblower Lawsuit

The federal government joined a private whistleblower lawsuit. The lawsuit had been filed under seal but made severe allegations that CityMD has now admitted to committing.

1-1-300x198Upcoding In The ER Could Be Stealing U.S. Tax Dollars

It’s an old and shady practice that has been in the forefront of Medicare and Medicaid fraud for years. Upcoding can hit taxpayers hard and drive emergency room bills to the thousands.

What is Upcoding?

According to a report just released by Health and Human services, nursing homes overcharged Medicare $1.5 million a year and that a majority of the overcharges involved claims from facilities that provide specialized care for more intensive services that were provided. The report cited documents showing Medicare was billed for work such as speech therapy and occupational therapy for patients who couldn’t benefit from it. The HHS inspector general has been studying Medicare billings for several years and said the government paid $32.2 billion to 15,000 skilled nursing facilities during the 2012 fiscal year.  The report focused on randomly selected samples of 499 claims submitted by 245 nursing homes around the US. Depending on the type of service, Medicare paid between $214 and $623 per patient per day in 2009. Investigators found that nursing homes provided more therapy during the period on which bills were based than other times of treatment.

Jeffrey Newman represents whistleblowers. jeffrey.newman1@gmail.com

A Charlotte North Carolina couple, Max and Jan Hauser, 70 and 71, will receive over $1.05 million as their share in the $5.25 million settlement reached by the Department of Justice with RxAmerica, a subsidiary of CVS Caremark under the False Claims Act. The lawsuit alleged that RxAmerican misrepresented to seniors the cost of prescription drugs on Medicare’s online “Plan Finder” that is used to compare the pricing and benefits of different Meciare D plants. Max and Jan Hauser said they had reviewed their insurance plans explanation of benefits form and realized that the company was charging more money to the Part D Plan considmers than it had represented in the Plan Finder. Jan Hauser, 71 said she and her husband were contacted by a lawyer who encouraged them to file the complaint after reading a newspaper article in 2008 describing their findings. Jan Hauser said that the settlement should show other seniors that it is important to review their Explanation of Benefits forms to make sure they are being charged correctly.

Jeffrey Newman represents whistleblowers. jeffrey.newman1@gmail.com