Medicare Fraud

In the United States, Medicare fraud is a general term that refers to an individual or corporation that seeks to collect Medicare health care reimbursement under false pretenses. There are many different types of Medicare fraud, all of which have the same goal: to collect money from the Medicare program illegitimately.The total amount of Medicare fraud is difficult to track, because not all fraud is detected and not all suspicious claims turn out to be fraudulent. According to the Office of Management and Budget, Medicare "improper payments" were $47.9 billion in 2010, but some of these payments later turned out to be valid.
Posts about Medicare Fraud
  • 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

    … no compassion for medical providers that rip off Medicare and Medicaid, we have zero tolerance and understanding for those that harm patients. They are monsters. According to court records, Lipkin falls into the latter category. Lipkin’s Medicare Fraud According to Manhattan’s U.S. Attorney, “[Lipkin] was a primary participant in a massive…

    Due Diligence- 13 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 -
  • 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 -
  • Pharmacist Guilty in Scheme Involving Counterfeit Drugs

    … Walter Beich, a 63-year-old pharmacist from Illinois, pled guilty to a Medicaid and Medicare fraud scheme involving filling prescriptions with counterfeit drugs. According to court records, Beich pled guilty to healthcare fraud and aggravated identity theft. He was facing trial on twelve charges before changing his plea. Beich’s Medicare Fraud…

    Due Diligence- 16 readers -
  • Medicare Fraud to Murder? Man who Owed Money Murdered

    … Readers of this blog know that we have long claimed that Medicare fraud is not a victimless crime. Often patients are harmed, receive substandard care or receive treatments and drugs they do not need simply so some doctor or clinic operator can bill more money to Medicare. Obviously, these schemes also hurt taxpayers. Medicare and Medicaid…

    Due Diligence- 12 readers -
  • 10 FLA Assisted Living Facility Owners Charged with Medicare Fraud

    …: Marlene Marrero, 60, of Miami Blanca Orozco, 69, of Miramar Norma Casanova, 67, of Miami Lakes Yeny De Erbiti, 51, of Miami Rene Vega, 57, of Miami Maribel Galvan, 43, of Miami Lakes Dianelys Perez, 34, of Miami Gardens Osniel Vera, 47, of Hialeah Alicia Almeida, 56, of Miami Lakes Jorge Rodriguez, 57, of Hialeah Congress long ago…

    Due Diligence- 16 readers -
  • Medicare Fraud Agency Turns 40… A Look Back

    … appointed an Irish mercenary soldier named Thomas Conway as the first IG. He would serve only a few months before a Prussian military general took the position, Baron Frederick William Augustus von Steuben. The OIG system of oversight never really spread after that until the 1970’s. Immediately after the resignation of Richard Nixon as President…

    Due Diligence- 19 readers -
  • Medicaid Fraud Doc Accused of Harming Tots

    … habits in every way possible.” Schneider faces five years on each of the 11 counts. At age 78, he could certainly spend the rest of his life behind bars. (Federal Medicare fraud charges are punishable by 10 years in prison, double if a patient was harmed.) Florida Medicaid Fraud and Whistleblower Awards This case was initiated by concerned parents…

    Due Diligence- 25 readers -
  • Health Information Coder to Get $5 Million Award

    … Coders and billing professionals are the backbone of the healthcare industry. Without proper coding, doctors, therapists and hospitals don’t get paid. Because of their unique position within the healthcare industry, a coder is often in the best place to spot fraud. As healthcare costs spiral out of control, the Centers for Medicare and Medicaid…

    Due Diligence- 10 readers -
  • Kwashiorkor, Upcoding, Medicare Fraud & Whistleblower Awards

    … False Diagnosis and Upcoding of Kwashiorkor Cases Can Lead to Medicare Fraud Whistleblower Awards Kwashiorkor and upcoding are not household words in the U.S. Many folks in the healthcare industry know the terms however. And in a weird way, they are usually related, at least in this country. We will start with Kwashiorkor first. Kwashiorkor…

    Due Diligence- 20 readers -
  • Whistleblower Gets $500,000+ in Medicare Patient Referral Scheme

    … and take advantage of the elderly and disabled.” He also acknowledged that the scheme put patients at risk. Whistleblower Awards and Medicare Fraud A healthcare whistleblower reporting Medicare or Medi-Cal fraud is entitled to receive a percentage of whatever the government receives from the wrongdoer. To qualify for a whistleblower award, one…

    Due Diligence- 9 readers -
  • Medicare Fraud: Pharmacy Owner Obstructs Audit

    … with criminal obstruction of the audit. At his arraignment he entered into a plea agreement and pleaded guilty. As part of his plea agreement, Logan admitted that he profited over a million dollars by using non-FDA approved ingredients in his compounded products. When sentenced, Logan faces five years in prison. Sentencing has been set…

    Due Diligence- 26 readers -
  • Drobot Cooperating, Sentencing Delayed – Healthcare Fraud Post

    … that between 2008 and April 2013, Pacific Hospital billed workers’ compensation insurance carriers approximately $500 million for these spinal surgeries! That resulted in kickbacks of between $20 million and $50 million! According to Los Angeles Magazine, Drobot’s scheme was like “an ATM card to Fort Knox.” To better protect his lucrative healthcare fraud…

    Due Diligence- 26 readers -
  • Whistleblower Receives $4.5 Million Award

    …, should receive $4.5 million for being the whistleblower who first reported the scheme. Hammett’s Complaint Against LMC Lexington Medical Center is 400+ bed hospital on the outskirts of Columbia, South Carolina. The hospital employs approximately 600 physicians. Until he was fired in 2013, Hammett worked as a neurologist for the hospital. When he…

    Due Diligence- 9 readers -
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