Boosts In Medicare Spending Due to Fraud, Report Says
March 23, 2009 by casey
USA Today on March 12, 2009, released the details of a Government Accountability Office report. According to the report, from 2002 to 2006, Medicare spending on home health services marked a 44% increase due in large part to fraudulent action by providers, including exaggerated patient medical conditions and billing Medicare for unnecessary services or care that was not provided. The 44% spending boost coincides with a mere 17% rise in Medicare enrollees during the same time period, for a total of $13 billion in spending for 2.8 million enrollees in 2006.
The home health services provided for by Medicare include visits by nurses, aides, physical therapists, and other medical professionals who monitor and treat surgical wounds, deliver medications, provide therapy and assist with other skilled care. In 2007, $16.5 billion of Medicare’s $455 billion budget was devoted to home care.
William Dombi, vice president for law at the National Association for Home Care & Hospice (the industry’s trade group), said the boost in spending combined with an increase in providers is a concern.
“We know from our own experience that kind of growth usually indicates something is wrong,” says Dombi. He says the industry is likely to back many of the GAO report’s recommendations.
The report suggests that the Centers for Medicare & Medicaid Servicse (CMS) consider criminal background checks on home health operators and draft new rules to ease the process of removing ‘problem providers’.
The government “is committed to continually reviewing and refining our processes to improve the Medicare program,” Acting CMS Administrator Charlene Frizzera wrote in response to the GAO report. She says Medicare is working to combat improper payments for home care services.
If you are witnessing fraud on the government, contact us by calling 800-377-1812 for strictly confidential advice from experienced counsel, with no fee obligation.
AT&T Will Pay $8.2 Million for Violating Disadvantaged Schools Program
March 19, 2009 by casey
The Department of Justice announced the settlement of a False Claims Act case involving AT&T Inc. on February 13, 2009. AT&T has agreed to pay $8,266,414.33 to resolve allegations that it violated the Federal Communication Commission’s E-Rate program. The E-Rate program enables disadvantaged schools and libraries to establish connections to and utilize the internet. Through funding collected from telephone users, the program provides schools with financial support to maintain their hardware and pay for service fees.
According to the DOJ, the case alleged that AT&T engaged in non-competitive bidding practices for E-rate contracts, received E-Rate funds for goods and services that were ineligible for the program’s discounts, and overbilled the program.
If you are witnessing fraud on the government, contact us by calling 800-377-1812 for strictly confidential advice from experienced counsel, with no fee obligation.
Forest Laboratories Accused of Illegal Drug Marketing
March 19, 2009 by casey
On February 25, 2009, the U.S. Department of Justice released a complaint against New York-based Forest Laboratories and their fraudulent practices in marketing the medications Celexa and Lexapro. Forest allegedly promoted the drugs for unapproved pediatric use and paid kickbacks to physicians who prescribed them. The illegal practices prompted the submission of thousands of false claims to federal healthcare programs.
The complaint, filed by numerous parties, claims that Forest actively marketed the drugs for pediatric use despite the FDA’s denial of a pediatric indication. It was alleged that a “double-blind, placebo-controlled, pediatric trial” deemed Celexa of no greater value than the placebo for pediatric use, and, furthermore, patients using Celexa recorded more suicide attempts and suicidal thoughts than the group using the placebo. Despite the study results, Forest continued the promotion of the drugs and deceived physicians and the public by failing to disclose the negative findings.
The United States has alleged that health care programs paid thousands of false claims for Celexa and Lexapro prescriptions that were were not covered for off-label pediatric use and were ineligible for payments due to illegal kickbacks. Forest allegedly attempted to induce physicians through expensive dinners, sumptuous entertainment, and various methods of illegal payment, including bribes masked as consulting fees or grants. All of these come in violation of the federal anti-kickback statute.
If you are witnessing fraud on the government, contact us by calling 800-377-1812 for strictly confidential advice from experienced counsel, with no fee obligation.
Suit Filed Against Amgen for Illegal Marketing of Drugs
March 19, 2009 by casey
Dow Jones reported on March 2, 2009, the filing of a lawsuit against Amgen Inc. for unlawful marketing of the drugs Enbrel and Aranesp. Through their committal of numerous illegal activities in the marketing of these medications, Amgen violated federal and state false claims laws, as well as the U.S. Food, Drug, and Cosmetic Act and Medicare and Medicaid anti-kickback laws.
Other claims in the case include Amgen’s improper marketing of the “attractive economics” of Aranesp to customers, providing discounts to customers and then failing to report such discounts, and marketing Aranesp and Enbrel off-label for uses not approved by the FDA. It is alleged that the biotechnology firm engaged in these activities to beat out Procrit, a rival medication.
If you are witnessing fraud on the government, contact us by calling 800-377-1812 for strictly confidential advice from experienced counsel, with no fee obligation.
