United States Attorney
Southern District of New York
FOR IMMEDIATE RELEASE
DECEMBER 6, 2005
UNITED STATES INTERVENES IN FALSE CLAIMS ACT LAWSUIT
AGAINST CABRINI MEDICAL CENTER ALLEGING ILLEGAL
MEDICAID PATIENT REFERRAL SCHEME
MICHAEL J. GARCIA, the United States Attorney for the Southern District of New York, announced today that on December 2, 2005, the Government filed a civil complaint against CABRINI MEDICAL CENTER (“CABRINI”). The complaint alleges that CABRINI entered into an illegal patient referral scheme with APPLIED CONSULTING, INC. (“CONSULTING”), and then falsely billed Medicaid for the care of these illegally-referred patients. CABRINI also allegedly billed Medicaid for alcohol and substance abuse detoxification treatment that it was not certified to provide.
OIG Proposes To Exclude Miami Hospital from Participation in Federal Health Care Programs
December 7, 2005 Washington, DC 20201
OIG Proposes To Exclude Miami Hospital from
Participation in Federal Health Care Programs
Inspector General Daniel R. Levinson announced today that the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) notified Miami’s South Shore Hospital and Medical Center (South Shore) of an impending exclusion from Medicare, Medicaid, and all other Federal health care programs. Today’s action resulted from South Shore’s material breach of the terms of a corporate integrity agreement (CIA) it negotiated with OIG in 2002, as part of the resolution of a False Claims Act case against the hospital.
BY JOHN DORSCHNER
In what could be the start of a massive crackdown on scams involving HIV/AIDS patients, law enforcement officials announced the arrest of four persons, including two doctors, charged with illegally diverting millions of dollars in drugs.
BY Jim Muir
BENTON - Benton dentist Dr. W. David Rommel was sentenced to 63 months in federal prison and ordered to repay $827,000 to the Illinois Department of Public Aid during a sentencing hearing Tuesday morning in U.S. District Court in Benton.
Nov 23 2005
A MAN who tried to fleece the NHS out of more than £8,000 was given a three-month suspended sentence this week.
Nursing home figure enters not guilty plea in fraud case
By Peter Shinkle
ST. LOUIS POST-DISPATCH
Robert D. Wachter, the former operator of a chain of nursing homes in the St. Louis area, pleaded not guilty Tuesday to charges that he conspired to defraud the government by providing substandard care at his facilities.
Hospital billing is complex and opportunities for fraud and gaming vary considerably by payment methodology. Cost-plus billing rewarded hospitals for having high overhead and inflating costs. Per diem systems encourage long lengths of stay and low complexity caseloads. DRG systems often have problems with upcoding (reporting a diagnosis or complication that increases payment). The lesson is that any payment system needs checks and balances.
I put all kinds of therapy fraud in this category. Mental health therapy fraud is probably most common and certainly caught more often than other types of therapy fraud. One common billing fraud is providing group therapy but billing for individual therapy.
I don’t usually focus on beneficiary fraud, but sometimes there are some extreme cases that I think are worth mentioning for the sheer gall of their actions. TennCare cracked down on beneficiary fraud in 2005 and has been prosecuting many interesting cases.
NASHVILLE – A Franklin County medical doctor has been charged with TennCare fraud. The Office of Inspector General (OIG) today arrested Dr. Floyd Brown, 54, an osteopathic specialist, of Estill Springs. He is charged with two counts of TennCare fraud for making false statements and concealing income information from TennCare. Read Press Release