Memorial Health, Inc. will pay $9.8 million to settle False Claims Act allegations in the largest civil healthcare fraud recovery ever recorded by the U.S. Attorney's Office for the Southern District of Georgia.
Last week, the Department of Justice released its annual report on False Claims Act recoveries in fiscal year 2015. Considering last year's historic $5.7 billion total, it was a little surprising--at least initially--to see FCA recoveries had dropped 40 percent. But there are a few explanations for the decline. Most importantly, it appears the government is struggling to keep pace with the flood of whistleblower claims, but recent announcements indicate the feds are in the middle of regrouping and could be joining up with whistleblowers with even more ferocity.
The second-highest biller for power wheelchairs received nearly $27 million in improper Medicare payments in 2010, according to a report from the Office of Inspector General.
The Office of Inspector General is recovering less money from fraud investigations, but the agency is clearly shifting its focus toward civil actions, according to information included in the OIG's Semiannual Report to Congress.
Half of the top 10 management and performance challenges identified by the Office of Inspector General in fiscal year 2015 have fraud, waste and abuse implications, according to a report released Tuesday.
As one of the youngest government-run health programs, Medicare Part D has been around for less than a decade, meaning it's just reaching the beginning stages of adolescence. And, like most...
Medicare Part D has been in effect for nearly 10 years, but it has accumulated a staggering list of deficiencies when it comes to fraud, waste and abuse. Most notably, the Centers for Medicare & Medicaid Services does not require Part D sponsors to report fraud, making it difficult to determine how much waste exists within the program. In an editorial for Forbes last week, Merrill Matthews, a resident scholar with the Institute for Policy Innovation in Dallas, described how Medicare Part D should be the posterchild for efficiency because of its low improper payment rate. But Matthews fails to acknowledge the pervasive vulnerabilities the Office of Inspector General and others have identified within the Part D program that have made it a target for fraud and abuse.
Medicare Part D pharmacy enrollment, drug reimbursement and durable medical equipment are among the new fraud and abuse focus areas targeted by the Office of Inspector General, according to agency's 2016 Work Plan.
The government resolved 110 cases involving civil monetary penalties and program exclusions in the past fiscal year, according to a senior official at the Office of Inspector General, and even more cases are expected in the coming year.
Two multi-million dollar cases against two ophthalmologists, including the headline-grabbing Salomon Melgen, have thrown the specialty into the regulatory hot seat. Add Melgen's high-profile case to payment data that lists Medicare payments to ophthalmologists that reach eight figures and an OIG report that identified $171 million in questionable claims, and you've got a recipe for additional federal scrutiny, plus potentially more fraud cases involving ophthalmologists.