Medicare Fraud Cases

United Healthcare Settles for $3.5 Million

Fraud Cases | Medical Equipment Fraud Cases | Medicare Fraud Cases
United Healthcare Insurance Company paid $3.5 million to settle a case that alleged that they defrauded Medicare by falsifying reports of how they handled phone inquiries. United Healthcare was acting as a Durable Medical Equipment Regional Carrier, responsible for processing DME claims submitted by Medicare providers and beneficiaries. United Healthcare did not admit any of the allegations. The case was the result of a qui tam lawsuit brought by a former United Healthcare employee. The whistleblower will receive $647,500 of the settlement. “This settlement demonstrates our continuing commitment to pursue vigorously allegations of fraud and abuse in Medicare,” said Peter Keisler, Assistant Attorney General for the Department’s Civil Division.

Maine Urologist Receives Light Sentence for Lupron Scam

News and Commentary | Fraud Cases | Kickbacks | Medicare Fraud Cases | Physician Fraud Cases | Prescription Drug Fraud

Dr. Joseph Olstein helped the government get a $1.2 billion settlement from TAP Pharmaceutical and AstraZeneca. In return he received only a light sentence for his part in the scam. The US Attorney announced that Olstein was sentenced this week to one year probation and a $20,000 fine (in addition to a previous $50,000 restitution payment).

Dr. Olstein pleaded guilty in 2001 to billing insurance companies for free samples of Lupron, which he received from TAP sales people. Lupron is an injectible drug used for treating prostate cancer. Physicians can bill Medicare and other insurers for injectible drugs. Because the free samples were given as a way for physicians to enhance their income, the samples are considered a kick-back. Without the kickbacks that TAP offered to urologists, an equivalent drug that is cheaper than Lupron would probably have been prescribed.

Costs and Savings in Medicare Change on Wheelchairs

News and Commentary | Fraud Cases | Medical Equipment Fraud Cases | Medicare Fraud Cases
Costs and Savings in Medicare Change on Wheelchairs - Medicare administrators late last fall began to take a closer look at reimbursement requests for power wheelchairs, an effort now saving the government millions of dollars. [New York Times Healthcare News] The beginning of this article talks about the hardships of small businesses and patients who are having trouble getting Medicare to pay for power wheelchairs. Sure, new rules may make it more difficult for everyone to get Medicare to pay for power wheelchairs, but the rules were enacted to control terrible abuse of the system.
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