MEDICARE FRAUD: Gov’t Urges Providers To ‘Fess Up’
The Department of Health and Human Services yesterday urged medical providers to "voluntarily confess to fraud or billing mistakes" involving federal health care programs. HHS Inspector General June Gibbs Brown said, "The government alone cannot successfully win the battle against health care fraud. Health care providers must be enlisted in this effort." In exchange for coming clean about any billing errors or fraud, Brown said "the provider may avoid an investigation by federal authorities and be allowed to settle the matter out of court." However, she noted that criminal activities could still be prosecuted, though "voluntary disclosure and cooperation will be noted in her recommendations to authorities." According to the AP/Boston Globe, the program "is an expansion of a two-year project originally open only to medical equipment companies, home health care agencies, nursing homes, and hospices in California, Florida, Illinois, New York, and Texas" (10/22).
First In Line
In "one of the first cases to be resolved under the 'voluntary disclosure'" initiative, Deborah Heart and Lung Center in Burlington County, NJ, agreed to pay the government $840,000 for overbilling Medicare. Brian Sherin, compliance chief at the hospital, said the overbillings were discovered in 1996, at which time administrators notified the government. He said the overbillings "were the result of a faulty computer program in 1994 and 1995." As part of the settlement, Sherin said the hospital will be required "to conduct periodic audits and take steps to ensure integrity" (Gold, AP/Bergen Record, 10/22).
Today's Miami Herald reports that federal investigators "charged 39 suspects Wednesday with three different counts of conspiracy to defraud" the Medicare program. The charges stem from an FBI/HHS sting in which investigators opened "a shell home-health company to unearth a lucrative system of scams, forgery and kickbacks." According to the Herald, the investigation "soon began targeting Amitan Health Services of Dade," and the charges filed yesterday accuse the agency of "filing false and fictitious claims for homebound patients, creating false medical documents to support the claims and working with businesses that would routinely inflate the costs of services" (Jervis, 10/22).
The Probe Widens
Department of Health and Human Services investigators plan to look into physician billings next year, according to a workplan released this month by the agency's inspector general's office. Modern Healthcare reports that agency officials "will begin their investigation in one unnamed state, reviewing the billing records to identify overpayments by Medicare or Medicaid." If "significant problems" are uncovered in that state, the agency plans to "expand the review to include other geographical areas and other types of providers," the workplan states. In addition, investigators will look into "whether the physicians use any automated encoding software to prepare their Medicare billings" -- software the workplan says "may increase the chance of billing errors." The workplan also makes clear that HHS plans to continue its ongoing probe of how physicians at teaching hospitals bill Medicare for their services, and investigators also will continue reviewing "physician incentives in managed care contracts."
Equipment Suppliers Beware! HMOs Too!
The inspector general's office workplan says investigators will probe "durable medical equipment suppliers to see if they are submitting duplicate bills to both DME regional carriers and regional home health intermediaries." Modern Healthcare also reports that HHS will look into whether managed care plans "should be held accountable for investment income they earn on Medicare funds before those funds are used to pay for services to enrollees." And the workplan states that the HHS inspector general's office projects an increase in the number of "'patient dumping' cases it investigates" (Hallam, 10/19 issue).