Medicare

In the United States, Medicare is a national social insurance program, administered by the U.S. federal government since 1966, that guarantees access to health insurance for Americans aged 65 and older who have worked and paid into the system, and younger people with disabilities as well as people with end stage renal disease (Medicare.gov, 2012) and persons with amyotrophic lateral sclerosis. As a social insurance program, Medicare spreads the financial risk associated with illness across society to protect everyone, and thus has a somewhat different social role from for-profit private insurers, which manage their risk portfolio by adjusting their pricing according to perceived risk.
Posts about Medicare
  • New Texas Law Targets Bad Nursing Homes

    … 328 nursing homes. How many of these nursing homes were fined? Only 22… According to Bob Jackson, state director of AARP in Texas, the problem exists because for many years the state simply allowed nursing homes to fix violations without facing any penalties. As a result, they have returned to her old habits time and time again. There are a large…

    Jeff Rasansky/ Rasansky Law Firm- 17 readers -
  • False Claims Act 101 – Intervened Cases vs Declined Cases

    … the defendant from further government contracts or participation in government programs. A hospital that can’t accept Medicare or a mortgage company that can’t write federally backed residential mortgages is probably going out of business. If the case doesn’t settle, the complaint is served on the defendant and the court process begins…

    Due Diligence- 11 readers -
  • Prime Pediatrics Dalton GA (New Medicaid Fraud Investigation)

    … or physician decides to defraud Medicaid, it is common to see multiple types of fraud taking place. Whistleblower Awards for Medicaid Fraud If Prime Pediatrics is double billing, substantial whistleblower awards may be available. The federal False Claims Act pays awards to people with inside information about fraud involving federally funded healthcare…

    Due Diligence- 20 readers -
  • Doc Injects Patients with Poison in Shocking Medicare Fraud Plot

    … Victor Lipkin will spend the next five years in prison. After pleading guilty to Medicare fraud last August, Lipkin was sentenced earlier this month by U.S. District Court Judge Ronnie Adams to 60 months in prison. His lawyers sought a 3 year sentence. Lipkin’s story echoes many others we have seen lately. Profits over patients. While we have…

    Due Diligence- 13 readers -
  • Tenet Exec INDICTED (Tenet Healthcare Whistleblower Post)

    … of the money that Tenet receives comes from Medicare and Medicaid. Under state and federal law, Medicare and Medicaid fraud is a crime. The government claims that Tenet Healthcare lied to the government for years by falsely claiming to comply with the 2006 Agreement. Major Fraud Against the United States The crime of Major Fraud Against the United…

    Due Diligence- 18 readers -
  • Big Pharma Wants Your Hearts, Minds and Wallets (Pharma Whistleblower)

    … about wrongdoing can earn a substantial cash award. To qualify for a pharma whistleblower award, one should be the original source of information relating to misuse of federal or state funds and programs. A large percentage of prescriptions drugs are paid through Medicaid, Medicare, the VA or Tricare. That means tax dollars. There are several…

    Due Diligence- 24 readers -
  • Kaiser Health News

    … 683,000 in California. Most of its members are enrolled in Medicaid or Medicare managed care plans. Dr. Mario Molina, president and CEO of Molina Healthcare, said he was “mystified” to learn about Figueroa’s lawsuit. Dr. Figueroa submitted claims that are not eligible for augmented payments under ACA program in discussion, Molina said…

    Due Diligence- 25 readers -
  • Florida Eye Clinic Accused of Medicare Fraud

    … Two former billing supervisors have accused the Florida Eye Clinic of a massive Medicare fraud scheme. William Lovell and Rochelle Mendez say the clinic billed Medicare for services never rendered. They say the clinic also overcharged for other services. According to the lawsuit, Florida Eye Clinic is owned by eight physicians. It employs 12…

    Due Diligence- 20 readers -
  • Kickbacks, RICO and the Pharmaceutical Industry (Insys Post)

    … prison? Prosecutors say they paid kickbacks to doctors who wrote prescriptions for their fentanyl based pain medication. Kickbacks in the healthcare setting are illegal. Medical decisions should be based on the best interest of the patient. Unfortunately, some pharmaceutical companies, ambulance services and hospitals use kickbacks to lure others…

    Due Diligence- 11 readers -
  • Does Universal Health Services Kidnap Patients?

    …, and chemical restraints, bad patient care, medication theft, you name it. The entire industry has very little oversight…” We are shocked by the allegations but have heard similar stories before. Private psychiatric hospitals make their money by filling up beds. As long as Uncle Sam or a private insurance plan is paying for a patient’s stay…

    Due Diligence- 12 readers -
  • Radiology Centers & Illegal Practices – Whistleblower Award Post

    … physician supervision. She also said the center was sometimes performing services without a prescription. Dye Contrast Studies Dye contrast studies involve injecting a patient with a special type of dye. The dye helps radiologists better view images. Because there is a risk of a severe allergic reaction, Medicare says that a doctor must be physically…

    Due Diligence- 13 readers -
  • Fla Hospital Pays $12mm in False Claims Act Whistleblower Case

    … The South Miami Hospital has agreed to pay approximately $12 million to settle charges that it violated the federal False Claims Act. Prosecutors say the nonprofit hospital submitted claims to Medicare for medically unnecessary pacemaker surgeries and cardiac electrophysiology studies. The fraud was tied to a single physician, Dr. John Dylewski…

    Due Diligence- 21 readers -
  • Big Whistleblower Retaliation Win – Mantech International

    … when the misconduct they report jeopardizes human lives… doctors performing unnecessary surgeries simply to collect Medicare payments, defense contractors providing defective body armor to our troops. Most of us work hard for a living. We also believe in the American dream where hard work can mean a better lifestyle. That is why no one likes…

    Due Diligence- 11 readers -
  • Federal Appeals Court Win for Whistleblowers

    … the Act, whistleblowers can file lawsuits on behalf of the United States. The law can only be used, however, if there is a loss or fraud involving government funds or programs. Examples include home health care agencies that defraud Medicare, defense contractors that bilk the military and mortgage companies that engage in bad underwriting practices…

    Due Diligence- 11 readers -
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