Small Pharmacy Chain Does the Right Thing

With Medicare and Medicaid fraud becoming more and more prevalent it is imperative that whistleblowers like Dan Bieurance and Neil Thompson do the right thing when companies like Walgreens repeatedly over-bill taxpayers. Not all pharmacy chains are as suspect. Take The Stop & Shop Supermarket Company (Stop & Shop), which recently voluntarily reported and returned $269,000 to the Massachusetts Medicaid Program.

From the Press Release:

Stop & Shop…discovered during an audit in 2006 that it had not reported the lowest price it had accepted for certain prescription drug products to MassHealth.  By not reporting the lower prices to MassHealth, Stop and Shop was overpaid by $269,000.  Massachusetts law requires pharmacies to charge Medicaid no more than the lowest price they are willing to accept from any “payer.”  If the pharmacies’ price is lower than the price calculated by the state’s pricing formula, then the state will pay the lowest price.

It is encouraging to see companies self-policing themselves and doing the right thing for their companies and American tax payers. When companies do engage in fraud, either as a mater of practice or oversight, whistleblowers must come forward to do the right thing for them.

Staten Island University Hospital to Pay U.S. $74 Million

September 23, 2008  
Filed under Cases in the News

The U.S. Department of Justice on September 15, 2008, released a settlement in which the Staten Island University Hospital (SIUH) has agreed to pay $74,032,565 to the United States and $14,883,883 to the State of New York to resolve claims of Medicaid, Medicare, and TRICARE (the U.S. military’s health insurance program) fraud. The total recovery of $88,916,448 is one of the largest ever against a single U.S. hospital.

Investigations carried out by the government established four individual cases of fraud.  Two of the four were introduced through suits filed by separate whistleblowers: Dr. Miguel Tirado, former Director of Chemical Dependency Services at SIUH, and Elizabeth M. Ryan, the widow of an SIUH cancer patient. Both individuals filed their suits through the federal False Claims Act, and Tirado also filed through the New York State False Claims Act.  In accordance with the settlement, the federal government will award Tirado with $2.3 million and Ryan with $3.75 million, and Tirado will also receive an additional $2.97 million from the State of New York.

In Tirado’s suit, government investigations established that from July 1994 to June 2000, SIUH had submitted claims for payment for detoxification treatment to patients for which the hospital had not received a license from the New York State Office of Alcoholism and Substance Abuse Services (OASAS). SIUH provided detoxification treatment in 12 more beds than it was authorized to do so. For this act of fraud, the hospital has agreed to pay the U.S. $11,824,056, and the State of New York $14,883,883.

In Ryan’s suit, it was found that from 1996 through 2004, SIUH had defrauded Medicare and TRICARE by using incorrect billing codes for cancer treatment in order to receive reimbursement for treatments covered by neither Medicare nor TRICARE. SIUH will pay $25,022,766 to the U.S. to settle this claim.

The other two claims established in the suit were resolved prior to its filing. The first concerns SIUH’s intentional inflation of its resident count from 1996 to 2003 in its “cost reports.” These cost reports provide the basis for how much Medicare determines to pay the hospitals for their Graduate Medical Education programs. For the settlement of this claim, SIUH has agreed to pay the U.S. $35,706,754.

In the final suit, it was found that SIUH improperly billed Medicare and Medicaid for treatment of patients in unlicensed beds from July 2003 to September 2005. The hospital has agreed to pay $1,478,989 to the U.S. to settle this claim.

In addition to the monetary penalties to be paid by SIUH, the hospital has also agreed to a Corporate Integrity Agreement with the Office of Inspector General, Department of Health and Human Services (OIG-HHS). In accordance with this agreement, SIUH will be required to maintain a compliance program to ensure against more fraud.

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.

CoxHealth Will Pay $60 Million to Settle Charges of Overbilling Medicare

August 20, 2008  
Filed under Medicare Fraud

The U.S. Department of Justice reported on July 26, 2008, the settlement of a False Claims Act case against CoxHealth of Springfield, Missouri.  Cox improperly billed and received payments from the Medicare trust fund, and agreed to pay $60 million to the United States in compensation.  It was also alleged that Cox provided kickbacks to physicians of the for-profit Ferrell-Duncan Clinic Inc.  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.

BlueCross Blueshield of Tennessee Agrees to $2.1 Million Settlement For Violating False Claims Act

August 20, 2008  
Filed under Medicare Fraud

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. 

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.

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