HHS inspector to step up anti-fraud and abuse efforts in 2012

Oct 7 2011

One new item on the to-do list will be to review hospitals deemed to be at high risk of submitting improper bills to Medicare. Also, The Fiscal Times details how lab test costs could be squeezing Medicare and Medicaid.

Modern Healthcare: Inspector General Plans Stepped up Oversight
With fraud and abuse enforcement in health care already reaching a high-water mark, HHS's Office of the Inspector General revealed plans for 2012 that call for even closer scrutiny of the massive industry. Among the new actions announced by the inspector general's office is an effort to review hospitals deemed "high risk" to submit improper bills to Medicare, according to the 165-page 2012 work plan released Wednesday (Carlson, 10/5).

The Fiscal Times: Lab-Test Scam Could Cost Medicare Billions
Despite recent court settlements that recouped more than a quarter billion dollars from lab-test companies for allegedly overbilling California' Medicaid program, the federal government seems to be ignoring similar schemes that drain Medicare coffers. The cases involve the nation' two largest medical laboratory-testing companies – Laboratory Corporation of America and Quest Diagnostics – that together control about half the annual $25 billion lab test market. The Medicare suits, filed in federal court in Manhattan by a former industry executive, claim the testing companies charged insurers like UnitedHealthcare unprofitably low rates while squeezing Medicare and Medicaid (Goozner, 10/6).

News outlets continue coverage of how a lobbying effort played into a Medicare fraud scheme.

Bloomberg: Medicare Thief Lobbied Congress To Preserve Government Funding, U.S. Says
A coalition of community mental-health clinics followed a playbook used by interest groups seeking U.S. government money: They created a trade association, doled out campaign contributions, and hired a former senator and Medicare administrator to lobby in Washington. The difference in this case is that some members of the association dedicated to fighting Medicare reimbursement cuts were stealing government money at the same time they were trying to keep it flowing, according to prosecutors. Lawrence Duran, a former board member of the trade group and an owner of Miami-based American Therapeutic Corp., a chain of seven clinics, was sentenced to 50 years in prison last month for orchestrating a $205 million Medicare fraud (Stern, 10/6).

The Washington Post: Health Executive Lobbied In Washington To Advance Medicare Fraud Scheme
Miami health-care executive Larry Duran orchestrated one of the largest Medicare frauds in U.S. history, submitting more than $205 million in phony claims and landing a record-breaking 50-year prison sentence for his crimes. But another piece of Duran's scheme also caught the eye of prosecutors. They say he extended his fraud through his lobbying efforts, all aimed at getting official Washington to make it easier for mental-health centers such as his to make money (Eggen, 10/5).