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

    … in Texas received only one or two stars out of five in the federal Centers for Medicare and Medicaid Services rating system. In addition, the state’s Department of Aging and Disability Services identified over 17,000 violations during the fiscal year 2015. Astonishingly, only 40 cases were subjected to any type of enforcement action. Violations…

    Jeff Rasansky/ Rasansky Law Firm- 18 readers -
  • False Claims Act 101 – Intervened Cases vs Declined Cases

    …. Civil War. Back then, the government was broke. All resources were diverted to support the Union Army and the war against the break-away Confederate states. The Justice Department simply didn’t have the money or personnel to pursue fraud claims. Back then, dishonest vendors were selling the Union Army bad wagons, lame mules and gunpowder…

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

    … that actually received, and billing for services that are not medically necessary. When unnecessary services are offered, patients are put at risk of physical harm. Medicare fraud can also include illegal kickbacks. The information that we have about Prime Pediatrics is limited to double billing. In our experience, however, once a clinic…

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

    … in the name of a particular doctor (the “Doctor”). While the scheme was fraudulent in numerous ways, the primary fraud involved scheme members recruiting and paying kickbacks to “patients” to take medically unnecessary tests and then billing the health insurance providers for those unnecessary tests.” The three clinics at issue in the scheme billed almost…

    Due Diligence- 14 readers -
  • Tenet Exec INDICTED (Tenet Healthcare Whistleblower Post)

    …. (We served as one of lead relators’ counsel in that case.) The only thing that gets the attention of the C-Suite Mafia is watching one of their own doing the “perp walk” on the evening news. Whistleblower Awards and Tenet Healthcare The $514 million fine last October resulted in an $84.4 million whistleblower award! A former Tenet Healthcare…

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

    … What do Donald Trump, Bernie Sanders and Bernie Sanders have in common? The answer? They all think that big pharmaceutical companies put profits before patients. Before the election, Hillary’s website had this to say about the pharmaceutical industry, “Her plan will demand a stop to excessive profiteering and marketing by denying tax breaks…

    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- 26 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- 21 readers -
  • Kickbacks, RICO and the Pharmaceutical Industry (Insys Post)

    … of those patients. That’s, that’s small potatoes. That’s nothing. That’s not what I’m here doing. I’m here selling [unintelligible] for the breakthrough pain. If I can successfully sell you the [unintelligible] for the breakthrough pain, do you have a thousand people in your practice, a thousand patients, twelve of them are currently on a rapid…

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

    … Investigations If you have information about any psychiatric healthcare provider that is detaining people without medical necessity, prescribing treatment or counseling that is not needed, paying kickbacks for psychiatric or addiction recovery referrals or charging for services not provided, contact us immediately. You may be eligible for an award…

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

    …. She also says the center paid kickbacks in the form of preferred provider discounts, forged prescriptions and operated several locations that were not licensed by Medicare. Rose Radiology Centers Settlement Rose ultimately settled both cases for a combined $8.71 million. The two women who brought the claims split a whistleblower award of $1.7…

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

    … to the systematic overutilization of medical procedures and inflated billing practices resulting in significantly increased costs to the federal government.” A Department of Health and Human Services special agent was blunter, “Performing medically unnecessary heart procedures is shocking to the conscience. Conducting cardiac catheterizations purely…

    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 -
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