"We expect health-care providers to come forward when they discover issues that could rise to the level of fraud without waiting for us to catch up to them," Fitzgerald said in a statement announcing the settlement.
Hospital settles fraud case for $36M
December 1, 2008 at 11:16 PM | Comments (0)
Condell Medical Center in Libertyville will pay a $36 million settlement to government health programs after the hospital said it accepted improper payments from federal health insurance programs for more than five years, the U.S. attorney's office in Chicago said Monday.
The improper payments, which Condell executives brougto the attention of the U.S. attorney, were uncovered in the process of the medical center's due diligence with Advocate Health Care, which Monday finalized a deal to buy the 283-bed hospital in Lake County for $180 million.
The settlement resolves deals that included improper loans made to physicians, leases with doctor practices that were below fair market value and hospital payments to doctors who performed "patient services without required written agreements," the U.S. attorney's office said in a statement.
Such deals were in violation of federal laws that essentially prohibit hospital payments to doctors for patient referrals. If a hospital, for example, leases space to a physician at below fair market value, that can be construed as a way to encourage doctors to send patients to the hospital leasing the space.
The deals led to millions of improper payments to the hospital from the Medicare health insurance program for the elderly and the state Medicaid health insurance program for the poor. The settlement, which involves improper deals from 2002 through 2007, calls for Condell to pay the federal government $33.12 million to resolve claims related to Medicare and $2.88 million to resolve claims related to Medicaid.
As part of the settlement, the U.S. attorney's office said Condell "does not admit liability and agreed to the settlement to avoid the delay, uncertainty and expense of protracted litigation."
"We regret that in the past Condell may have been engaged in any practices that were not compliant with the law, and remain committed to the highest standards of conduct," said Dennis Millirons, Condell's chief executive officer.
By voluntarily disclosing the illegal relationships and contracts, "Condell avoided a government lawsuit under the federal False Claims Act and was able to negotiate a settlement at a discount," the U.S. attorney's office said. Such a lawsuit could have led to a settlement that would have cost Condell another $10 million or more, according to federal formulas used to calculate health care settlements.
Still, U.S. Atty. Patrick J. Fitzgerald praised Condell "for bringing these practices" to the government's attention.
"We expect health-care providers to come forward when they discover issues that could rise to the level of fraud without waiting for us to catch up to them," Fitzgerald said in a statement announcing the settlement.
--Bruce Japsen
http://www.chicagobreakingnews.com/2008/12/condell-fraud-settlement.html
Showing posts with label Healthcare Reform. Show all posts
Showing posts with label Healthcare Reform. Show all posts
Friday, December 5, 2008
HHS and DOJ Health Care Fraud and Abuse Control Program
HHS and DOJ Health Care Fraud and Abuse Control Program
Annual Report For FY 2007
The Department of Health and Human Services And The Department of Justice Health Care Fraud and Abuse Control Program
Annual Report For FY 2007,
November 2008
"The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established a national Health Care Fraud and Abuse Control Program (HCFAC or the Program), under the joint direction of the Attorney General and the Secretary of the Department of Health and Human Services (HHS)1, acting through the Department’s Inspector General (HHS/OIG), designed to coordinate Federal, state and local law enforcement activities with respect to health care fraud and abuse. In its eleventh year of operation, the Program’s continued success again confirms the soundness of a collaborative approach to identify and prosecute the most egregious instances of health care fraud, to prevent future fraud or abuse, and to protect program beneficiaries."
Permanent Link Topic(s): E-Government, Government Documents
Annual Report For FY 2007
The Department of Health and Human Services And The Department of Justice Health Care Fraud and Abuse Control Program
Annual Report For FY 2007,
November 2008
"The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established a national Health Care Fraud and Abuse Control Program (HCFAC or the Program), under the joint direction of the Attorney General and the Secretary of the Department of Health and Human Services (HHS)1, acting through the Department’s Inspector General (HHS/OIG), designed to coordinate Federal, state and local law enforcement activities with respect to health care fraud and abuse. In its eleventh year of operation, the Program’s continued success again confirms the soundness of a collaborative approach to identify and prosecute the most egregious instances of health care fraud, to prevent future fraud or abuse, and to protect program beneficiaries."
Permanent Link Topic(s): E-Government, Government Documents
If only there were also programs like this in developed countries.
Monday, December 01, 2008
Two Important Resources Last month, I was fortunate to be able to attend the 13th International Anti-Corruption Conference in Athens, Greece, where I learned about two important additions to our resources relevant to the issues discussed on Health Care Renewal, specifically to improving integrity and transparency to the manufacture, promotion, and use of pharmaceuticals.
The Medicines Transparency AllianceFormed this year, this group seeks to bring "together at both the international and national levels, a diverse group of people with an interest in the pharmaceutical sector (stakeholders) to find ways to improve information flows, and increase transparency and accountability about the selection, regulation, procurement, sale, distribution and use of medicines in developing countries. By doing so, MeTA will improve how decisions are made about medicines, improve the way they are purchased and supplied, encourage innovative and responsible business practices, and increase the voice of patients and consumers." The Alliance will be focused mainly on developing countries, so that "when a country implements MeTA, it makes a commitment to progressively disclose a standard set of core data covering the quality, availability, price and promotion of medicines. This commitment also includes fully involving civil society, business and other stakeholders to work together to generate, disclose, debate and use these data to help address problems in the pharmaceutical market."
The Alliance has launched programs in Peru and Ghana, and plans to launch programs in Kyrgyzstan and Jordan.
The World Health Organization (WHO) Good Governance for Medicines Programme
This program has been in operation for several years, but seems to have a new and improved web-site. The site notes "Theft, extortion and abuse …the US$ 3 trillion-plus spent on health services worldwide each year are an obvious target for corruption. In fact, Transparency International estimates that 10 to 25 % of global public health procurement spending is siphoned off and stolen. Life-saving resources are being snatched away from the millions of people that need them most. The pharmaceutical sector, with its US$ 600 billion-plus global market value, is vulnerable to fraud." The goal of the programme "is to improve this situation. Guided by WHO’s Medicines Strategy 2004-2007 and launched in late 2004, the programme is raising awareness of abuse in the public pharmaceutical sector and promoting good governance. Its ultimate aim is to ensure that essential medicines reach people - not the black market."
If only there were also programs like this in developed countries.
Labels: Medicines Transparency Alliance, pharmaceuticals, WHO Good Governance for Medicines Programme
posted by Roy M. Poses MD at 11:42 AM
Links to this post
Two Important Resources Last month, I was fortunate to be able to attend the 13th International Anti-Corruption Conference in Athens, Greece, where I learned about two important additions to our resources relevant to the issues discussed on Health Care Renewal, specifically to improving integrity and transparency to the manufacture, promotion, and use of pharmaceuticals.
The Medicines Transparency AllianceFormed this year, this group seeks to bring "together at both the international and national levels, a diverse group of people with an interest in the pharmaceutical sector (stakeholders) to find ways to improve information flows, and increase transparency and accountability about the selection, regulation, procurement, sale, distribution and use of medicines in developing countries. By doing so, MeTA will improve how decisions are made about medicines, improve the way they are purchased and supplied, encourage innovative and responsible business practices, and increase the voice of patients and consumers." The Alliance will be focused mainly on developing countries, so that "when a country implements MeTA, it makes a commitment to progressively disclose a standard set of core data covering the quality, availability, price and promotion of medicines. This commitment also includes fully involving civil society, business and other stakeholders to work together to generate, disclose, debate and use these data to help address problems in the pharmaceutical market."
The Alliance has launched programs in Peru and Ghana, and plans to launch programs in Kyrgyzstan and Jordan.
The World Health Organization (WHO) Good Governance for Medicines Programme
This program has been in operation for several years, but seems to have a new and improved web-site. The site notes "Theft, extortion and abuse …the US$ 3 trillion-plus spent on health services worldwide each year are an obvious target for corruption. In fact, Transparency International estimates that 10 to 25 % of global public health procurement spending is siphoned off and stolen. Life-saving resources are being snatched away from the millions of people that need them most. The pharmaceutical sector, with its US$ 600 billion-plus global market value, is vulnerable to fraud." The goal of the programme "is to improve this situation. Guided by WHO’s Medicines Strategy 2004-2007 and launched in late 2004, the programme is raising awareness of abuse in the public pharmaceutical sector and promoting good governance. Its ultimate aim is to ensure that essential medicines reach people - not the black market."
If only there were also programs like this in developed countries.
Labels: Medicines Transparency Alliance, pharmaceuticals, WHO Good Governance for Medicines Programme
posted by Roy M. Poses MD at 11:42 AM
Links to this post
Tuesday, June 17, 2008
South Florida region bills Medicare more than $2 billion each year
Miami - Home to the largest health-care fraud by one person by B.A.C., 06/13/2008
Hats off to our local High School dropout Rita Campos Ramirez for orchestrating the largest single person Medicare fraud in US history! Rita managed to scam the government for $105 million over 4 years and treated herself to two condos and a benzo. As a result of her conviction by the man the government has been able to convict others who were implicitly involved in her scheme. It seems Rita isn't the only one milking the system here in Miami either;
Investigators and prosecutors trained their focus on Miami after noticing two troubling patterns:
HHS investigators discovered that nearly half of 1,581 medical equipment companies they visited in the Miami area did not comply with basic Medicare requirements to be open during scheduled hours and to have a telephone number. The inspector general and the Government Accountability Office have flagged weak oversight of these kinds of suppliers for a dozen years, according to congressional testimony.
The South Florida region bills Medicare more than $2 billion each year for injectable HIV medications. That figure is 22 times as high as the amount of similar claims in the rest of the country, and is far out of line with demographic data in a population of 2 million people in Miami-Dade County, HHS statistics show.
Now thats the American dream ladies and gentleman. Drop out of school yet still be savvy enough to swindle the American government for $104 mil. I am applauding you at this moment Rita and I'm certain many other dropouts here in Miami are ready to take your place and lead the charge for the continued labeling of Miami as the only third world city in the USA.
[MSNBC 'Rags to riches' through Medicare fraud]
Hats off to our local High School dropout Rita Campos Ramirez for orchestrating the largest single person Medicare fraud in US history! Rita managed to scam the government for $105 million over 4 years and treated herself to two condos and a benzo. As a result of her conviction by the man the government has been able to convict others who were implicitly involved in her scheme. It seems Rita isn't the only one milking the system here in Miami either;
Investigators and prosecutors trained their focus on Miami after noticing two troubling patterns:
HHS investigators discovered that nearly half of 1,581 medical equipment companies they visited in the Miami area did not comply with basic Medicare requirements to be open during scheduled hours and to have a telephone number. The inspector general and the Government Accountability Office have flagged weak oversight of these kinds of suppliers for a dozen years, according to congressional testimony.
The South Florida region bills Medicare more than $2 billion each year for injectable HIV medications. That figure is 22 times as high as the amount of similar claims in the rest of the country, and is far out of line with demographic data in a population of 2 million people in Miami-Dade County, HHS statistics show.
Now thats the American dream ladies and gentleman. Drop out of school yet still be savvy enough to swindle the American government for $104 mil. I am applauding you at this moment Rita and I'm certain many other dropouts here in Miami are ready to take your place and lead the charge for the continued labeling of Miami as the only third world city in the USA.
[MSNBC 'Rags to riches' through Medicare fraud]
Wednesday, February 6, 2008
Have you asked yourself, WHy does your Employer dictate what health care you receive?
Op-Ed Columnist
The Cooper Concerns
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Del.icio.usDiggFacebookNewsvinePermalinkBy DAVID BROOKS
Published: February 5, 2008
I’m not a Hillary-hater. She’s been an outstanding senator. She hung tough on Iraq through the dark days of 2005. In this campaign, she has soldiered on bravely even though she has most of the elected Democrats, news media and the educated class rooting against her.
Related
Blogrunner: Reactions From Around the WebBut there are certain moments when her dark side emerges and threatens to undo the good she is trying to achieve. Her campaign tactics before the South Carolina primary were one such moment. Another, deeper in her past, involved Jim Cooper, a Democratic congressman from Tennessee.
Cooper is one of the most thoughtful, cordial and well-prepared members of the House. In 1992, he came up with a health care reform plan that would go on to attract wide, bipartisan support. A later version had 58 co-sponsors in the House — 26 Republicans and 32 Democrats. It was sponsored in the Senate by Democrat John Breaux and embraced by Daniel Patrick Moynihan, among others.
But unlike the plan Hillary Clinton came up with then, the Cooper plan did not include employer mandates to force universal coverage.
On June 15, 1993, Cooper met with Clinton to discuss their differences. Clinton was “ice cold” at the meeting, Cooper recalls. “It was the coldest reception of my life. I was excoriated.”
Cooper told her that she was getting pulled too far to the left. He warned that her plan would never get through Congress. Clinton’s response, Cooper now says, was: “We’ll crush you. You’ll wish you never mentioned this to me.”
In the weeks and months following that meeting, the Clinton administration reached out to Cooper. As David Broder and Haynes Johnson wrote in “The System,” their history of the health care reform effort, President Bill Clinton invited Cooper to go jogging and play golf. Others in the Clinton White House thought Cooper was right on the merits, and privately let him know.
But Hillary Clinton set up a war room to oppose Cooper, who was planning to run for the Senate in 1994. As the Broder and Johnson book makes clear, Clinton and her aides believed Cooper was pursuing his own political agenda. They accused him of crafting his plan in order to raise money from the insurance and hospital industries. They said he was in league with the for-profit hospitals to crush competitors and monopolize the industry. They did this despite the fact that Cooper’s centrist health care approach was entirely consistent with his overall philosophy.
At one meeting in the West Wing, a source told Broder and Johnson, Clinton “kind of got this evil look and said, ‘We’ve got to do something about this Cooper bill. We’ve got to kill it before it goes any further.’ ”
Clinton denounced the Cooper plan as “dangerous and threatening.” Deputies were dispatched to Tennessee to attack his plan. Senator Jay Rockefeller said that Cooper is “a real fraud. I hope he doesn’t make it to this place.” According to Newsweek, Clinton brought an aide with a video camera to a meeting with senators and asked the senators to denounce Cooper on the spot.
The Clinton effort backfired. It temporarily raised his profile back home. Her health care reform failed, too. She says she’s learned the lessons from that failure, but she remains icy toward Cooper. Her health care memos, including a three-page memo drafted in preparation for her meeting with Cooper, have not been made public by the National Archives.
Moreover, the debate Clinton is having with Barack Obama echoes the debate she had with Cooper 15 years ago. The issue, once again, is over whether to use government to coerce people into getting coverage. The Clintonites argue that without coercion, there will be free-riders on the system.
They’ve got a point. But there are serious health care economists on both sides of the issue. And in the heat of battle, Clinton has turned the debate between universal coverage and universal access into a sort of philosophical holy grail, with a party of righteousness and a party of error. She’s imposed Manichaean categories on a technical issue, just as she did a decade and half ago. And she’s done it even though she hasn’t answered legitimate questions about how she would enforce her universal coverage mandate.
Cooper, who, not surprisingly, supports Barack Obama, believes that Clinton hasn’t changed. “Hillary’s approach is so absolutist, draconian and intolerant, it means a replay of 1993.”
He argues that her more coercive approach would once again be a political death knell. No Republican will support it. Red state Democrats will face impossible pressures at home. It’s smarter to begin by offering people affordable access to coverage and evolve from there.
Cooper is, of course, a man who has been burned in the past. But it is legitimate to wonder if adults can really change all that much. A defter politician would have reached out to Cooper and made an attempt to address the concerns he represents.
The Cooper Concerns
Sign In to E-Mail or Save This Print Share
Del.icio.usDiggFacebookNewsvinePermalinkBy DAVID BROOKS
Published: February 5, 2008
I’m not a Hillary-hater. She’s been an outstanding senator. She hung tough on Iraq through the dark days of 2005. In this campaign, she has soldiered on bravely even though she has most of the elected Democrats, news media and the educated class rooting against her.
Related
Blogrunner: Reactions From Around the WebBut there are certain moments when her dark side emerges and threatens to undo the good she is trying to achieve. Her campaign tactics before the South Carolina primary were one such moment. Another, deeper in her past, involved Jim Cooper, a Democratic congressman from Tennessee.
Cooper is one of the most thoughtful, cordial and well-prepared members of the House. In 1992, he came up with a health care reform plan that would go on to attract wide, bipartisan support. A later version had 58 co-sponsors in the House — 26 Republicans and 32 Democrats. It was sponsored in the Senate by Democrat John Breaux and embraced by Daniel Patrick Moynihan, among others.
But unlike the plan Hillary Clinton came up with then, the Cooper plan did not include employer mandates to force universal coverage.
On June 15, 1993, Cooper met with Clinton to discuss their differences. Clinton was “ice cold” at the meeting, Cooper recalls. “It was the coldest reception of my life. I was excoriated.”
Cooper told her that she was getting pulled too far to the left. He warned that her plan would never get through Congress. Clinton’s response, Cooper now says, was: “We’ll crush you. You’ll wish you never mentioned this to me.”
In the weeks and months following that meeting, the Clinton administration reached out to Cooper. As David Broder and Haynes Johnson wrote in “The System,” their history of the health care reform effort, President Bill Clinton invited Cooper to go jogging and play golf. Others in the Clinton White House thought Cooper was right on the merits, and privately let him know.
But Hillary Clinton set up a war room to oppose Cooper, who was planning to run for the Senate in 1994. As the Broder and Johnson book makes clear, Clinton and her aides believed Cooper was pursuing his own political agenda. They accused him of crafting his plan in order to raise money from the insurance and hospital industries. They said he was in league with the for-profit hospitals to crush competitors and monopolize the industry. They did this despite the fact that Cooper’s centrist health care approach was entirely consistent with his overall philosophy.
At one meeting in the West Wing, a source told Broder and Johnson, Clinton “kind of got this evil look and said, ‘We’ve got to do something about this Cooper bill. We’ve got to kill it before it goes any further.’ ”
Clinton denounced the Cooper plan as “dangerous and threatening.” Deputies were dispatched to Tennessee to attack his plan. Senator Jay Rockefeller said that Cooper is “a real fraud. I hope he doesn’t make it to this place.” According to Newsweek, Clinton brought an aide with a video camera to a meeting with senators and asked the senators to denounce Cooper on the spot.
The Clinton effort backfired. It temporarily raised his profile back home. Her health care reform failed, too. She says she’s learned the lessons from that failure, but she remains icy toward Cooper. Her health care memos, including a three-page memo drafted in preparation for her meeting with Cooper, have not been made public by the National Archives.
Moreover, the debate Clinton is having with Barack Obama echoes the debate she had with Cooper 15 years ago. The issue, once again, is over whether to use government to coerce people into getting coverage. The Clintonites argue that without coercion, there will be free-riders on the system.
They’ve got a point. But there are serious health care economists on both sides of the issue. And in the heat of battle, Clinton has turned the debate between universal coverage and universal access into a sort of philosophical holy grail, with a party of righteousness and a party of error. She’s imposed Manichaean categories on a technical issue, just as she did a decade and half ago. And she’s done it even though she hasn’t answered legitimate questions about how she would enforce her universal coverage mandate.
Cooper, who, not surprisingly, supports Barack Obama, believes that Clinton hasn’t changed. “Hillary’s approach is so absolutist, draconian and intolerant, it means a replay of 1993.”
He argues that her more coercive approach would once again be a political death knell. No Republican will support it. Red state Democrats will face impossible pressures at home. It’s smarter to begin by offering people affordable access to coverage and evolve from there.
Cooper is, of course, a man who has been burned in the past. But it is legitimate to wonder if adults can really change all that much. A defter politician would have reached out to Cooper and made an attempt to address the concerns he represents.
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