Hospital admits accepted improper payments from federal health insurance programs for more than five years...and only has to pay 36 mil?

"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

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

Fraud & Compliance Forum in Baltimore next month.

FORT LAUDERDALE, FL (September 17, 2008) Health care fraud blog publisher, attorney Robert David Malove, will be attending the 2008 Fraud & Compliance Forum in Baltimore next month.

The AHLA/HCCA Fraud & Compliance Forum will provide practical guidance on the pressing legal and compliance issues that have arisen in the last twelve months. For health lawyers, the program will highlight the most important legal developments in areas such as Stark, the False Claims Act, and the Anti-Kickback Statute. For compliance officers, the conference will cover important issues such as Part D compliance plans, compliance effectiveness, and fraud and abuse. The program’s uniqueness stems not only from the important content for health lawyers and compliance officers but also from the additional value of bringing together legal counsel and compliance officers in one educational arena. The networking opportunities and synergistic advances in fraud and abuse compliance make this program an essential educational forum for both health lawyers and compliance officers.

The Fraud & Compliance Forum is jointly sponsored by the Health Care Compliance Association (HCCA) and the American Health Lawyers Association (AHLA). It includes an explicit designation of each session as “compliance focused” or “legal focused.” The Planning Committee has included enough sessions in each designation that an individual could attend all “compliance” sessions or all “legal” sessions for the entire program. Yet an attendee also has the option of selecting a diversity of sessions and networking with an expanded group of individuals. The Fraud & Compliance Forum has the benefit of combining the quality of HCCA and AHLA sessions with the expanded networking power of a combined program.

Program Goals and Objectives:

Participants at the AHLA/HCCA Fraud & Compliance Forum will:

* Gain a greater understanding of the full nature of the various regulations governing the delivery of healthcare (Stark, False Claims Act)
* Recognize emerging regulatory trends that will affect legal and compliance practices in healthcare
* Network with peers and learn about the challenges and risk areas faced by a wide variety of healthcare settings (hospitals, academic medical centers, physician practices, long-term care providers, pharmaceutical manufacturers)
* Recognize the common issues faced by compliance and legal professionals, the roles each play in ensuring compliance and ways in which they can effectively work together

HCA INC/TN Richard Rainwater & George W Bush

Person
CRAIG E. GARDELLA

Records 1 - 18 of 18.
Company Name Form Type Received Date View
COMMUNITY HEALTH SYSTEMS INC 8-K 7/30/2007
HCA INC/TN 8-K 11/3/2005
PSYCHIATRIC SOLUTIONS INC 8-K 12/28/2004
HCA INC/TN 8-K 11/10/2004 PSYCHIATRIC SOLUTIONS INC 10-Q 8/11/2004
RENAL CARE GROUP INC 8-K 4/16/2004
HEALTHCARE REALTY TRUST INC 10-Q 11/14/2003
HEALTHWAYS, INC 8-K/A 10/10/2003
RFS PARTNERSHIP LP 8-K 1/16/2003
RFS HOTEL INVESTORS INC 8-K 1/16/2003
NORTHWEST AIRLINES CORP 10-Q 11/6/2002
AUTOZONE INC 8-K 10/1/2002
BUCKEYE TECHNOLOGIES INC 10-K 9/20/2002
BUCKEYE TECHNOLOGIES INC 10-Q 5/14/2002
NORTHWEST AIRLINES CORP 10-K405 4/1/2002
RESORTQUEST INTERNATIONAL INC 10-Q 11/14/2001
THOMAS & BETTS CORP 10-Q 8/15/2001
BUCKEYE TECHNOLOGIES INC 10-Q 5/2/2001

"...largest health-care fraud settlement ever registered in the United States. "

The hospital agreed to return $25 million to the federal government

Ten years they were robbing Medicare and Tricare....and what do they have to pay?
The hospital will also have to pay another $26.6 million to cover Medicare and Medicaid reimbursements it received for treating thousands of patients for substance abuse using unregulated and unlicensed methods between 1994 and 2004.


Wednesday, September 17, 2008
Staten Island University Hospital to Pay $88.9M in Fraud Case - efluxmedia.com - 16 Sep 2008

New York’s Staten Island University Hospital will have to pay $88.9 million to federal and state authorities in the largest health-care fraud settlement ever registered in the United States.

A lawsuit filed in federal court in Brooklyn accused the hospital of fraudulently billing Medicare, Medicaid, and TRICARE, the insurance offered to military personnel, between 1994 and 2005.


The settlements stem from two False Claims Act suits filed by whistleblowers, as well as two investigations by the US Attorney’s Office and the state Attorney General’s Office. The fraud schemes date between 1994 and 2005, according to officials. Part of the settlements covers work done by Dr. Gilbert Lederman’s radiation oncology department.


"This was a hospital that sought to exploit the Medicare program and obtain millions of dollars in payments that it was not entitled to," said Richard Reich, lawyer for federal whistleblower Elizabeth Ryan, who brought the first case against Lederman and the hospital. Investigators in this case determined that the hospital used incorrect billing codes in cancer treatment from 1996 through 2004 to Medicare and TRICARE. The hospital agreed to return $25 million to the federal government. Ms. Ryan, the widow of a hospital’s patient, will receive $3.75 million.


The hospital will also have to pay another $26.6 million to cover Medicare and Medicaid reimbursements it received for treating thousands of patients for substance abuse using unregulated and unlicensed methods between 1994 and 2004.

A statement released by the hospital said: “We want to assure our patients and the communities we serve that SIUH will continue to deliver the same high-quality care that has enabled us to win coveted national awards.”

By Anna Boyd

CBO suggests.....

The federal budget deficit was $486 billion in the first 11 months of fiscal year 2008, CBO estimates, $212 billion more than the shortfall recorded over the same period last year. CBO anticipates that the government will realize a surplus in September, stemming from quarterly payments of estimated income taxes. The result will be a deficit in the vicinity of $400 billion for the fiscal year. CBO will release a new estimate of the 2008 deficit and updated baseline projections for fiscal years 2009–2018 on September 9.

The CBO,Congressional Budget Office, analyses and informs that the Health Care Cost, if not addressed in the very near future will be in a CRISIS!
Really? As if it is not already?

The biggest drivers in the CBO:
Medicare
Medicaid
Social Security

Study suggests health care fraud drives up medical costs
Birmingham Business Journal
Friday, September 5, 2008

Just take a look at some of the fraud listed in this blog.

"...health care fraud drives up medical costs" Really?

Friday, September 5, 2008
Study suggests health care fraud drives up medical costs
Birmingham Business Journal



While health care companies are spending billions on construction, a recent study has found that health care fraud may be one of the biggest factors driving up health care costs, to the tune of billions of dollars, new research indicates.

Resolved health care fraud cases alone in the previous decade involved $9.3 billion in damages paid to both federal and state government, according to researchers at Brigham and Women’s Hospital.

Results of the study are slated to be published in the Sept. 2 issue of the Annals of Internal Medicine.

But the researchers said the data suggest that there is likely much more unrecognized fraud still going on within the health care system, adding countless inefficiencies that drive up costs.

Indianapolis day care defrauded the Indiana Medicaid Program of nearly $2 million.

INDIANAPOLIS -- A woman who ran an Indianapolis day care has been indicted on federal charges she defrauded the Indiana Medicaid Program of nearly $2 million.

Carol Y. Woodard, 40, was indicted Monday on health care fraud charges, said U.S. Attorney Timothy Morrison.

Woodard enrolled her day care and after-school care business, Gideon's Gate, in the Medicaid program and collected $1.8 million for services never rendered, including therapy for traumatic brain injury, Morrison said Woodard was not in federal custody Monday. A telephone call to a number listed in Woodard's name was not answered Monday evening.

Woodard faces up to 10 years in prison and a $250,000 fine. An initial hearing before a federal magistrate is scheduled for Sept. 2.

Copyright 2008 by The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

.....problem that costs the healthcare system an estimated $60 billion a year at the lowest estimate, and perhaps as much as $200 billion a year,.....

Healthcare fraud doesn’t even get a mention in the recently released government plan for creating a nationwide health information network.


REALLY? My same sentiments regarding the CAMPAIGN and FIXING the HEALTHCARE SYSTEM in this country.



Tackle fraud issue now, IT leaders advise
Jul 25th, 2008 | By Vantage Technology | Category: Healthcare IT

Healthcare fraud doesn’t even get a mention in the recently released government plan for creating a nationwide health information network.
Donald W. Simborg, MD, headed a team that worked on the problem of fraud for the Office of the National Coordinator. It’s a problem that costs the healthcare system an estimated $60 billion a year at the lowest estimate, and perhaps as much as $200 billion a year, Simborg told an audience at the 3rd Annual Leadership Summit on The Road to Interoperability, held in Boston earlier this week

Simborg chaired a follow-up panel that came up with a list of 14 specific recommendations that could be built into the review process used by the Certification Commission for Healthcare Information Technology.

“So what happened to our recommendations?” Simborg asked. “Well, it got a lot of push-back.”

On some level, Simborg expected resistance. Requiring fraud protections would perhaps slow the already snail-like pace of EMR adoption - at 4 percent, compared with 90 percent in every other industrialized country, according to David Bates, MD, medical director at the Harvard University-affiliated Partners HealthCare in Boston.

“What I didn’t expect was that (the Office of the National Coordinator) would totally drop fraud management from its plan,” Simborg said. “What I can’t understand is why we don’t try to solve this problem.”

“What I find astounding,” said Reed Gelzer, MD, a member of CCHIT’s privacy and compliance panel and co-founder of Advocates for Documentation Integrity and Compliance, “we are essentially suggesting our healthcare organizations adopt systems for which there are virtually no standards and minimal certifications. Where’s the discussion of the fact that we are killing 50,000 to 100,000 people a year?”

Simborg, who has been a vocal supporter of EHR adoption for more than 30 years, is a co-founder and member of Health Level 7, a founding member of the American College of Medical Informatics and a board member of the Foundation on Research and Education at the American Health Information Management Association (AHIMA).

In his view, the focus on promoting adoption, which goes back to President George W. Bush’s mention of electronic medical records in his State of the Union Address in 2004, might prove fruitless.

“Unless the focus changes,” he said, “adoption of electronic health records will lead to higher healthcare costs without much benefit. Without proactive fraud management, whatever the problem is will be much greater in an electronic environment.”

Beyond that, there are other issues.

The physician savings derived from electronic health records most often come from coding increases - what Simborg called “E&M code creep.” The E&M stands for evaluation and management.

“We need to have fundamental changes in how we pay physicians,” Simborg said.

While electronic health records provide a legitimate way for physicians to speed up their documentation, they also increase costs, he said.

He noted that when he developed a commercial EHR for oncologists, “our customers had an increase in billing that provided ROI in two years. More than half came from coding increases.”

Simborg suggests that adoption per se is not the goal.

“If driving value means slower adoption, that’s OK,” he said.

He recommends continuing “what we do right:”

Work on interoperability and certification;
Eliminate E&M payments based on volume of documentation;
Promote P4P models;
Build in decision-support and add incentives based on documented behavior change (over time, though, even that can be gamed, he said);
And tackle the issue of fraud management.
“Clearly we have to put fraud management in there somewhere,” he said. “The elephant has to be slain.”

“The issue is patient literacy,” said Charles Jaffe, MD, chief executive officer of HL7. “When we put down our list of to-dos, let’s make sure there are others in the equation besides providers.”