BlueCross Blueshield of Tennessee Agrees to $2.1 Million Settlement For Violating False Claims Act
August 20, 2008 by casey
On August 11, 2008, the Department of Justice announced a $2.1 million settlement to be paid by BlueCross BlueShield of Tennessee (BCBS-T) to the United States. BCBS-T, which operates as Riverbend Government Benefit Administrators, agreed to the settlement in response to allegations of its violating the False Claims Act.Â
The allegations against BCBS-T came in response to the company’s failure to modify the cost-to-charge ratios of hospitals in the state of New Jersey, for which it is the primary Medicare Part A Fiscal Intermediary (Part A Fiscal Intermediary’s are private insurance companies that manage Medicare claims). Because the cost-to-charge ratios were not conducted in a timely manner, many medical facilities were given excessive “outlier payments,†or supplementary reimbursements for unusually high-costing care, by Medicare.
“Today’s settlement demonstrates that the Justice Department will be vigilant in protecting the Medicare program from all who abuse it, including contractors that falsely bill for crucial tasks that they do not perform,” said Gregory G. Katsas, Assistant Attorney General of the Civil Division.
If you are seeing fraud on the government, contact us by calling 800-377-1812 for strictly confidential advice from experienced counsel, with no fee obligation.
Connecticut Hospital Settles False Claims Case
March 13, 2008 by brian
The Yale Daily News and U.S. Attorney Kevin O’Connor announced on March 8, 2008, that Yale-New Haven Hospital agreed to pay a $3.78 Million fine on a False Claims Act case for Medicare fraud allegations, stemming from over billing of Medicare for infusion therapy, chemotherapy and blood transfusions on patients.
The Oncology Infusion Service was also accused of giving medications and conducting lab studies without a doctor order. Federal Medicare only allows payment for one unit of infusion therapy, chemotherapy or blood transfusion per patient per day, but the hospital had billed Medicare as often as five times per day for the same patient. This is the second False Claims Act settlement by this hospital.
If you are seeing fraud on the government, contact us by calling 800-377-1812 for strictly confidential advice from experienced counsel, with no fee obligation.
Cathedral Healthcare Fraud Settlement
March 10, 2008 by brian
The Earth Times and the U.S. Department of Justice reported on March 4, 2008, settlement of a False Claims Act case against Cathedral Healthcare System, Inc. in New Jersey. Whistleblowers Peter Salvatori and Sarah Iveson will receive $848,000 of the $5.3 Million settlement paid by Cathedral.
The hospital system improperly increased charges to Medicare patients to obtain higher Medicare reimbursement from the federal government. The whistleblowers helped the federal government with the evidence that Cathedral had wrongfully increased charges for both inpatient and outpatient care of Medicare patients, illegally obtaining higher “outlier†type payments from Medicare than the hospital system was entitled to receive.
If you are seeing fraud on the government, contact us by calling 800-377-1812 for strictly confidential advice from experienced counsel, with no fee obligation.
Warren Whistleblowers Win Medicare Fraud Case
December 20, 2007 by bob
Peter Salvatori and Sara Iveson will share in $1.2 million dollars for their role in a Medicare fraud case against Warren Hospital of Phillipsburg, New Jersey. This is part of a of a 7.5 million dollar settlement that the hospital agreed to after charges were brought under the Federal False Claims Act.
According to the U.S. Department of Justice, the hospital inflated Medicare charges to receive payments it wasn’t entitled to between January 1998 and August 2003. The allegations related to Medicare’s costliest treatments. Patients under such care are called ‘outliers’ because their needs stretch beyond typical parameters of the program.
Indicators have suggested that this is just another example of rampant Medicare Fraud. From The Morning Call:
Whistle-blowers have tipped off the government to $1.3 billion worth of fraud cases in the last year, largely at hospitals or other health care providers, the Justice Department said.
The department recovered $3.1 billion from individuals and companies during the fiscal year that ended Sept. 30, 2006.
In return, whistle-blowers were paid $190 million for alerting the government to the fraud.
For the basics on prevention and detection check out the US Department of Health’s Medicare Fraud page.
