Feds: NH hospital to pay $2.2 million settlement - Boston.com

Dartmouth-Hitchcock Medical Center will pay more than $2.2 million to settle charges it improperly billed various federal health programs, Vermont's top federal prosecutor said Tuesday.

Of the total, more than $80,000 will go to the state of Vermont, $61,000 to New Hampshire, $1.5 million to the federal government and more than $334,000 will go to Dr. Thomas Prendergast, the former Dartmouth-Hitchcock physician who blew the whistle on the improper billing.

Based in Lebanon, N.H., Dartmouth-Hitchcock is a major teaching hospital affiliated with the Dartmouth Medical School and has a big footprint in northern New England. It discharged more than 13,000 New Hampshire patients in 2010 and nearly 10,000 from Vermont.

Prendergast told authorities the hospital improperly billed federal programs including Medicare, Medicaid, Veterans Affairs and the military's Tricare health insurance system for services delivered by resident physicians in training who were unsupervised by more senior attending physicians.

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Want Medicare To Pay For Home Care? See Your Doctor : Shots - Health Blog : NPR

Starting next month, seniors getting health care in their homes will have to see a doctor to make sure they actually need the service. Otherwise Medicare won't pay.

Sounds logical, right?

Not so, says a coalition of health providers and consumer groups that complains the rule is overly burdensome on seniors and doctors.

 

Home health agencies, doctor and consumer groups say frail, homebound seniors won't be able to get to a doctor's office because of their health status or lack of doctors in rural areas.

They also worry that many doctors are either unaware of the new regulation or won't know how to comply with its documentation requirements that call on physicians to certify they or another health care provider, such as a nurse practitioner, have seen a patient for the specific reason of certifying the need for home health care.

"There is a lot of confusion out there, and patients may lose access to their care," said Nora Super, an AARP lobbyist.

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Sisters accused of health fraud nabbed in Colombia | Reuters

Two sisters accused of falsifying health care claims to defraud the U.S. government of millions of dollars were nabbed in Colombia and returned to the United States, authorities said on Tuesday.

Caridad Guilarte, 54, and Clara Guilarte, 56, ran a clinic in Dearborn, Michigan, that billed about $9 million in claims for treatments patients never received, according to the U.S. Department of Health and Human Services website.

The sisters collected more than $4 million from Medicare for drug therapies that were never provided, according to the HHS website.

After the FBI interviewed them, the two sisters fled, said Barbara McQuade, the U.S. attor

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Medical News: Operation Targets $225M in Healthcare Fraud - in Public Health & Policy, Medicare from MedPage Today

By Joyce Frieden, News Editor, MedPage Today Published: February 18, 2011

WASHINGTON -- The largest healthcare fraud operation in U.S. history has nabbed suspects accused of collectively defrauding Medicare of more than $225 million, according to officials from the Department of Health and Human Services (HHS) and the Department of Justice (DOJ).

The Medicare Fraud Strike Force charged 111 defendants in nine cities for their alleged participation in Medicare fraud schemes, officials announced on Thursday. Defendants included doctors, nurses, and healthcare company owners and executives, among others.

"With this takedown, we have identified and shut down large-scale fraud schemes operating throughout the country. We have safeguarded precious taxpayer dollars. And we have helped to protect our nation's most essential healthcare programs, Medicare and Medicaid," said Attorney General Eric Holder in a statement. "As [these] arrests prove, we are waging an aggressive fight against healthcare fraud."

More than 700 law enforcement agents from the FBI, the HHS Office of Inspector General, multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies participated in the operation.

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Doctors who order tests for their own financial gain-KevinMD.com

Doctors who order tests for their own financial gain

6 comments

in Physician practice

by Kohar Jones, MD

“What a shame,” said my eighty eight year old Armenian grandmother, shaking her head with sorrow, and I had to agree. “US officials charge 73 people, mostly Armenians, over a massive fraud against the country’s medical insurance system,” read the BBC headline.

A (mostly) Armenian crime syndicate set up 115 sham clinics in the United States, using real doctors’ names and real patient information, stolen from different systems, to generate false Medicare claims.

Dermatologists examined hearts.  ENT doctors performed pregnancy ultrasounds. (And Medicare beneficiaries, it must be noted, are usually past child-bearing age.)

At some point, $35 million later, someone noticed the discrepancies. How broken is our health care payment system that an interstate, international mafia could steal $35 million from US taxpayers via false Medicare claims? How broken is our health care payment systems than an upstart Armenian mafia would even decide that Medicare should become the new black market, filled with low-hanging fruitful ways to make an easy buck? Whatever gave them the idea?

Perhaps they learned from low-level not-quite-gangsters racketeering their way to easy profits—the real doctors in real storefront clinics seeing real patients, for example, who happen to have high blood pressure– performing EKGs every three months for no good medical reason. Should we call it a scam when real doctors refer real patients to the imaging sites down the road in which the doctors have partial ownership, to perform imaging studies for no strong medical indication? How might this contribute to a “massive fraud” of medical overutilization?

The Armenian Medicare Mafia brings shame to my ethnicity. Doctors who order for their own financial gain, I believe, bring shame to my profession.

Three cheers for shame-free doctoring! Let us give patients what patients need, no less and certainly no more.

Kohar Jones is a family physician who blogs at Progress Notes.

via kevinmd.com

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