Nursing Homes, Social Security and Medicare Fraud
(6/20/11)- In a hearing before a Congressional panel, Patrick P. O'Carroll Jr., the inspector general for Social Security estimated that the Social Security Administration made $6.5 billion in overpayments to people not entitled to receive them in 2009. About 10% of the payments made by the agency's Supplemental Security Income (SSI) program were improper.
Most of the payments went to people who did not report all their assets. Error rates were much smaller for retirement, survivor and disability payments, which make up the bulk of Social Security disbursements, according to Mr. O'Carroll.
(4/13/11)- Senators Ron Wyden (D., Ore) and Charles Grassley (R., Iowa) introduced legislation aimed at overturning the 1979 court injunction that bars the government from revealing information from the Medicare database. Both senators serve on the Senate Finance Committee, which oversees Medicare and Medicaid.
The Medicare Data Access for Transparency and Accountability Act, or DATA Act is aimed at allowing access to Medicare doctor and medical professionals billings for the purpose of determining acts of fraud. In issuing the injunction in 1979, the judge ruled that physicians' privacy overrode the public's in finding out how tax dollars were being spent by the government.
He relied on a privacy provision in the Freedom of Information Act (FOIA). The new bill explicitly exempts physician Medicare billing data from that FOIA provision. Please see our item dated 3/10/11 below.
(3/10/11)- Senator Charles Grassley (Rep.-Io.) and Senator Ron Wyden (Dem.-Ore.) have drafted separate legislation aimed at overturning the 1979 court injunction that bars the public from finding out how much individual physicians earn from Medicare. For additional information on this topic see our item dated 2/5/11 below.
That injunction stemmed from a suit filed by the Florida Medical Association, and the American Medical Association, the doctor's trade group against President Jimmy Carter who sought to have published a list of all annual Medicare medical reimbursements to physicians and medical professionals. That ruling remains in effect today.
Senator Grassley said his bill was aimed at changing the court decision. "The intention is to make government transparent, because with transparency there comes accountability."
Senator Wyden said he had drafted his legislation "designed to make (the Medicare) database public." He said he planned to talk to Senator Grassley to see if they could join forces in getting a bipartisan bill passed by Congress to remedy this situation.
(2/5/11)- There has been a lot of publicity about trying to uncover Medicare fraud, but were you aware of the fact that there is a Medicare database that is kept by the government, but it can not be searched by those seeking to uncover Medicare fraud?
Dow Jones & Co., the publishers of the Wall St Journal which in turn is owned by Rupert Murdoch's News Corp., filed a suit in the U.S. District Court for the Middle District of Florida seeking to overturn a decades long court order barring public access to this database.
The plaintiffs claim that the 1979 injunction is hampering its efforts to detect fraud by Medicare doctors who under the ruling are free from public scrutiny.
The American Medical Association has withstood at least 2 cases that sought to overturn the injunction. In one case, the U.S. Court of Appeals for the District of Columbia ruled that under the Freedom of Information Act, physicians' privacy interest outweighed the public interest in finding out how much doctors were being paid by their Medicare patients.
"It's time to overturn an injunction that, for decades, has allowed some doctors to defraud Medicare free from public scrutiny,: was the comment from Dow Jones general counsel Mark Jackson.
(11/26/09)- Excerpts from a new federal report, obtained by the Associated Press, show a dramatic increase in improper payments in the $440 billion Medicare program. The report claimed that the government paid more than $47 billion, yes that is billion, in questionable Medicare claims. This was almost a threefold increase over last year's level.
Much of the increase is attributed to a change in the Health and Human Services Department's methodology that imposes stricter documentation requirements and includes more improper payments, including medical treatment showing little relation to a patient's condition.
President Obama is expected to announce new initiatives to help crack down on Medicare fraud, including a government-wide Web site aimed at providing a fuller account of health-care spending and improper payments made by various agencies.
(8/23/08)- A recent report from the Office of Inspector General for the Department of Health and Human Services concluded that Medicare fraud is much more widespread than previous reports from Medicare had indicated.
The report scrutinized a program known as Comprehensive Error Rate Testing, or CERT, that audits a sample of Medicare claims submitted by sellers of durable medical equipment. CERT randomly reviews the medical records and other supporting documents to determine if Medicare has made correct payments.
AdvanceMed Corp., a subsidiary of Computer Science Corp., does the auditing for Medicare. The agency had previously reported to Congress that, for fiscal year 2006, AdvanceMed's investigators had found that 7.5% of claims paid by Medicare were not supported by appropriate documentation. The inspector general's review indicated that the actual error rate was closer to 31.5%.
The report alleges that AdvanceMed's auditors were told by Medicare officials to ignore government policies that would have accurately measured fraud. For example, auditors were told not to compare invoices from salespeople against doctors' records, as required by law, to make sure that medical equipment went to actual patients.
"This is outrageous," said Senator Charles E. Grassley, the top ranking Republican on the Senate Finance Committee, which oversees Medicare and Medicaid. " If heads don't roll, you can't change the culture of this organization".
(2/6/00)-The Justice Department's San Francisco office and the Inspector General of the Department of Health and Human Services announced that they had secured the largest settlement against a nursing home for fraud in a nursing home case. Beverly Enterprises Inc. the parent company of Beverly Healthcare, the nation's largest nursing home chain has agreed to pay a civil settlement fine of $170 million and to relinquish control of 10 of their homes in California. Their subsidiary, Beverly-California, will pay a $5 million criminal fine settlement.
Under the terms of the settlement Beverly will pay $25 million within 30 days to the government. The balance of $145 million will be deducted from Medicare reimbursements to the chain over an 8-year period of time. The settlement also included a corporate integrity agreement that provides for a reporting and compliance program to be overseen by the company and the Office of Inspector General.
The government's case alleged that Beverly had falsely inflated the number of hours nurses spent caring for Medicare patients at the 10 California homes and elsewhere. The government further alleged that the chain had submitted false nurse sign-in sheets and other fabricated documents to support the bills.
Beverly-California will plead criminally guilty to one count of fraud through an inter-state carrier in connection with a cost report relating to one facility, and 10 counts of making false statements to Medicare. The charges arose for the period of time from 1992 to 1998.
We urge our viewers to report to Medicare fraud to the proper authorities when they become aware of it. Cutting back on fraud not only saves the taxpayers money, but will mean a monetary reward for the "whistle blower" who helps bring the fraud to the government's attention, and there is a recovery of $100 or more. The fraud hotline telephone number is 1-800-HHS-TIPS or 1-800-447-8477.
FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "How to Select a Nursing Home"
By Allan Rubin
updated June 20, 2011
http://www.therubins.com
To e-mail: hrubin12@nyc.rr.com or rubin@brainlink.com