Be on the lookout, fraudsters: The federal governent is bearing down hard on misappropriated Medicare funds. A new report shows that the Health Care Fraud and Abuse Control Program (HCFAC), combining efforts of HHS and the Department of Justice (DOJ), returned $1.7 billion to the Medicare Trust Fund in 2016.
HHS' Office of Inspector General (OIG) alone brought 765 criminal actions against Medicare and Medicaid abusers in 2016, while the DOJ filed criminal charges in 480 cases. The
Feb. 6 issue of Part B News explained one such case, in which a physician practice was convicted of billing erroneous home-visit claims after the practice sent an "unlicensed" individual to hundreds of patients' homes.
While the 2016 fraud and abuse report
details dozens of unsavory criminal cases,
Part B News had the unenviable task of choosing a select group for our readers. We'll call this the curating of criminalities, or the identifying of ignominies. Please stay tuned to future editions, but in the meantime sink your teeth into the basest of the base:
The abroad and spectral case. "In April 2016, a licensed physician pleaded guilty to health care fraud, admitting that he submitted false claims to Medicare for purported visits with Medicare beneficiaries, including on dates when he was out of the country, for beneficiaries who were deceased on the dates he purportedly treated them, and for services totaling more than 24 hours in one day. He agreed that he submitted approximately $2.4 million in fraudulent claims to Medicare for which he was paid approximately $1.2 million." Lesson: As they say in baseball, three strikes and you're out.
The see-and-be-seen mystery. "In June 2016, the University of Missouri-Columbia paid the United States $2.2 million to settle allegations that it violated the civil FCA by submitting claims for radiology services to federal health care programs. The United States alleged that certain attending physicians certified that they had reviewed the images associated with interpretative reports prepared by resident physicians when, in fact, they had not reviewed those images. As a part of settlement, the University of Missouri-Columbia entered into a five-year Corporate Integrity Agreement with HHS-OIG." Lesson: If a tree falls in the forest, can you report it?
The have-a-heart edition: "In December 2015 a Westlake, Ohio cardiologist was sentenced to 20 years in prison for overbilling Medicare and private insurers for unnecessary catheterizations, tests, stent insertions and causing unnecessary coronary artery bypass surgeries. He performed medically unnecessary nuclear stress tests and inserted cardiac stents in patients who did not have 70 percent blockage or any blockage in their cardiac vessel. He also placed a stent in an already stenosed artery which not only failed to provide any medical benefit but also increased the risk of harm to the patient. As a result of this scheme, the cardiologist caused Medicare to be overbilled in the amount of approximately $29 million, and Medicare and the private insurers paid him approximately $5.7 million." Lesson: If you have a heart, then use it. Especially on Valentine's Day.