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Archive for October, 2006

No Mercy for Keystone Mercy Health Plan

Keystone Mercy Health Plan has agreed to pay $5 Million to Medicaid to settle allegations involving overpayments they filed to return to the Pennsylvania Department of Public Welfare. Lorraine Pittelli, a former Keystone Mercy claims-recovery examiner filed a whistleblower complaint and will receive $780,000 from the settlement .

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Are Unnecessary Heart Surgeries Being Performed?

A False Claims Act complaint has been filed against St. Edward Mercy Medical Center and heart surgeon alleging that unnecessary heart surgeries have been performed to defraud Medicare and other federal health care programs. The complaint , filed jointly by a former patient and a cardiologist, accuses the hospital of knowing that the defendant heart surgeon was performing unnecessary surgeries. For more information click here.

2006: Here’s to a Banner Year!

This year, the False Claims Act (in its revitalized form) is celebrating its 20th anniversary, but that’s not the only reason to celebrate. According to Taxpayers Against Fraud (TAF), fiscal year 2006 will be a record year for False Claims Act recoveries, as TAF estimates total settlements and judgments will top 3.142 billion. As it relates to healthcare fraud, a TAF -sponsored study concluded that the False Claims Act is returning more than $15 to the Federal Treasury for every dollar invested in investigations and prosecutions. How’s that for a good investment return?

One of Nation’s Largest Ambulance Company Pays $9 Million for False Claims

American Medical Response (AMR), based in Greenwood, Colorado and considered one of the largest U.S. ambulance providers has paid the United States over $9 million to resolve claims that the company violated the False Claims Act by providing illegal inducements to hospitals in Texas in exchange for referrals. These swapping arrangements gave the medical facilities discounts on transports in exchange for the referral of ambulance transports of patients being discharged from the hospitals, which were billed to Medicare. Two former employees of AMR blew the whistle and will each receive $1,620,000 as the result of the settlement. For more information click here.

False Claims Act is the Cure for Nursing Home Industry Fraud

The only truly effective tool legal experts say for rooting out fraud, abuse and neglect in the nursing home industry falls under the False Claims Act.  According to Lou O’Reilly, founder of Texas Advocates for Nursing Home Residents, “We need more lawsuits filed against providers using the False Claims Act and have them pay back the government for abuse and neglect of residents. Maybe it would clean up the bad nursing homes. ” For more information click here