Despite the rampant efforts by the federal government’s H.E.A.T. task force, healthcare fraud and Medicare false claims continue to plague American taxpayers. When it comes to bilking federal healthcare agencies out of money, the following methods are some of the most common:
▪ Medically unnecessary procedures: Medicare and Medicaid guidelines expressly set forth threshold requirements for administering certain medical procedures and diagnostic tests. Billing for services to treat patients who do not meet these standards is considered medically unnecessary billing.
▪ Upcoding: Upcoding is an illegal process by which a medical practice enters codes for services that include enhanced procedures or additional time with the doctor when, in reality, services that bill at a lower rate were actually rendered.
▪ False Billing: Lastly, billing for services that were never rendered at all is an obvious and common violation of the False Claims Act.
In today’s post, we look at a Grand Rapids, Michigan, medical corporation that was engaging in routine, intentional false billing on behalf of Medicare enrollees receiving rehabilitative services at one of its many centers.
Details of the case against Agility Health and Oceana County Medical Care Facility
In one of the most recent healthcare fraud settlements, Agility Health and Oceana County Medical Care Facility have agreed to pay $1 million to settle allegations of fraudulent billing against Medicare. The case was brought to light by three courageous whistleblowers, who are set to receive $200,000 collectively for their efforts in exposing the fraud.
In 2008, Agility Health Services entered into an agreement with Oceana County Medical Care wherein the former would manage the latter’s rehabilitative healthcare services. Thereafter, allegations reveal that Agility Health procured protected and privileged healthcare information about some of its patients for purposes of billing for medical equipment that was never actually received or used by the centers. According to the whistleblowers’ assertions, the companies were also billing the government for rehabilitation on behalf of patients who were physically and/or mentally incapable of participating in such activities.
The U.S. Attorney’s Office commented on the matter, stating, “Patients in skilled nursing facilities should receive therapy based on their clinical needs, not the financial incentives of the companies and facilities that provide their care….Patients also trust providers to protect their sensitive personal information as required by law. My office will use all available options to hold providers accountable when they improperly disclose protected health information.”
Contact Berger Montague today
If you are aware of potential billing and coding fraud in your place of employment, you may be able to file your own False Claims Act lawsuit against your employer, which includes protections against retaliation. For more information about this process, please contact Berger Montague today.