Entries in healthcare (5)


Government Makes Arrests for $430 Million in Health Care Fraud

iStockphoto/Thinkstock(WASHINGTON) -- Nearly 100 people have been arrested in a series of raids targeting health care fraud on a massive scale. Doctors, nurses, even top hospital administrators in eight cities in seven states were arrested in connection with separate scams totaling $430 million -- nearly a half billion dollars in pilfering. All kinds of fraud are alleged, much of it involving false billing for services that were unnecessary, or never even rendered.

"Today's enforcement actions reveal an alarming and unacceptable trend of individuals attempting to exploit federal health care programs to steal billions in taxpayer dollars for personal gain," said Attorney General Eric Holder during a press conference in Washington, D.C. "Such activities not only siphon precious taxpayer resources, drive up health care costs, and jeopardize the strength of the Medicare program -- they also disproportionately victimize the most vulnerable members of society, including elderly, disabled and impoverished Americans."

Ninety-one alleged fraudsters were targeted in cities that include Los Angeles; Miami; Dallas; Houston; Tampa; Baton Rouge; Chicago; and Brooklyn, N.Y. Together, those indictments charge more than $230 million in home health care fraud, more than $100 million in mental health care fraud, more than $49 million in ambulance transportation fraud, and millions more in other frauds. The defendants charged are accused of various crimes, including conspiracy to commit health care fraud, health care fraud, violations of the anti-kickback statutes, and money laundering.

"Today's coordinated operation demonstrates that law enforcement is flexible enough to address health care fraud in its many evolving forms," said HHS Inspector General Levinson. "When home health agencies, durable medical equipment companies, pharmacies or other health care providers are suspected of breaking the law, they can expect to be caught and held accountable."

Some of the government accusations involve allegations of stunning audacity.

According to the Justice Department, seven individuals are charged in Houston for their participation in a fraud scheme at a hospital that led to $158 million in fraudulent billing for community mental health center services. "The defendants who served as administrators at the hospital paid kickbacks -- in the form of cigarettes, food and coupons redeemable for items available at the hospital's 'country stores' -- to Medicare beneficiaries in exchange for those beneficiaries' attendance at the hospital's partial hospitalization programs (PHP)," Justice Department officials said. "Allegedly, beneficiaries watched television, played games and engaged in other non-PHP activities rather than receiving the services for which the hospital billed Medicare."

"In Brooklyn, 15 individuals, including one doctor and four chiropractors, are charged for their alleged participation in various fraud schemes involving a total of $23.2 million in false billings. In one case, nine defendants, including a medical doctor, are charged with participating in a fraud scheme at Cropsey Medical Care PLLC which led to approximately $13.8 million in fraudulent billing for physical therapy and related services. According to court documents, the defendants paid cash kickbacks to Medicare beneficiaries in exchange for physical therapy that was not medically necessary and on some occasions never provided to beneficiaries."

"In Baton Rouge, four defendants, including a licensed practical nurse, are charged for their roles in fraud schemes involving approximately $2.4 million in false claims for medically unnecessary durable medical equipment."

Since its inception in March 2007, the federal strike force has charged more than 1,480 defendants who collectively have falsely billed the Medicare program for more than $4.8 billion.

Copyright 2012 ABC News Radio


Supreme Court Will Soon Discuss Petitions on Healthcare Law

iStockphoto/Thinkstock(WASHINGTON) -- President Obama and opponents of the Affordable Care Act should know in a little more than two weeks if the Supreme Court will rule on the national healthcare law by next year.

The high court will discuss five petitions from three appeals court decisions on the law at a conference set for Nov. 10, with its findings made public four days later.

Given its full slate of cases, the earliest the judges could hear arguments about the constitutionality of the law is late February, although late March is more probable with a ruling likely coming in June.

At the core of the case is whether the government can mandate Americans to purchase medical coverage.  If the Supreme Court strikes down this provision, the rest of the healthcare law might not stand up to legal scrutiny.

So far, appeals courts have been split on the issue.  Meanwhile, 26 Republican attorneys general have filed a petition for the court to overturn the Affordable Care Act in its entirety.

Copyright 2011 ABC News Radio


Supreme Court Returns to Consider Health Care, GPS Technology, Strip Searches and More

United States Supreme Court(WASHINGTON) -- The highest court in the land is ramping up for its 2011 term, and facing some potentially monumental cases.

Looming over the start of the Supreme Court's term is the question of when the justices will hear a challenge to President Obama's Affordable Care Act, the constitutionality of which has been challenged by lower courts in 26 states. 

But the Court is already set to hear an interesting range of other cases, including law enforcement's use of global positioning systems, the government's policy of indecency on the broadcast airwaves and the constitutionality of strip searches for minor offenses. Here's a look at the docket's major cases:

The Affordable Care Act:

Lower courts are divided on the issue of whether the health care law's key provision -- the individual mandate forcing individuals to buy health insurance by 2014 or pay a penalty -- is constitutional. On Wednesday night, the Obama administration asked the Court to review the case it lost in the 11th Circuit Court of Appeals.

Because the government is asking the Supreme Court to step in and address a major act of Congress that has divided the lower courts, the Justices are expected to render a decision before the next election.

GPS and Law Enforcement:

In the court's most important Fourth Amendment case in a decade, the justices will weigh an individual's expectation of privacy against law endorsement's use of increasingly sophisticated technology to follow suspects on public property.

The case stems from the 2008 case in which Antoine Jones was convicted on drug charges. Law enforcement used a variety of techniques to link Jones to other co-conspirators and one technique was a or GPS device installed secretly -- without a valid warrant -- on a Jeep used by Jones in order to track his movements by satellite.

Broadcast Indecency:

The Supreme Court will also hear a challenge brought by broadcast television against the government's policy on indecency on the airwaves from 6 p.m. to 10 p.m.

At issue are the "fleeting expletives" uttered by celebrities such as Cher and Nicole Richie televised during primetime on Fox Television, as well as an episode of NYPD Blue on ABC which showed a woman's unclothed backside.

The Federal Communications Commission, charged with regulating indecency over public airwaves, ruled in both instances that the broadcasters had violated its policy.

In court briefs, the government defended the FCC's policy, arguing the "pervasiveness of foul language, and the coarsening of public entertainment in other media such as cable, justify more stringent regulation of broadcast programs so as to give conscientious parents a relatively safe haven for their children."

Strip Searches:

Lower courts have split on the issue as to whether reasonable suspicion is needed before strip searching an individual entering the prison population.

In 1979, the Supreme Court ruled that in the interest of security, prisons could conduct visual body cavity searches of all detainees after they had contact with outsiders. For years after that ruling, lower courts ruled that the prison had to have a reasonable suspicion that the arrestee was concealing contraband before subjecting him to a strip search upon entering the facility.

But in recent years, courts have begun to allow a blanket policy to strip search all arrestees. The Obama administration has filed a "friend of the court" brief arguing that the need for security in the jails outweighs the individual privacy rights regarding strip searches.

It points out that the Federal Bureau of Prisons houses more than 216,000 pretrial detainees and convicted inmates, and subjects them all to visual body cavity inspections before they can be placed in the general prison population.

Copyright 2011 ABC News Radio


Obama Misstated Story about Mother's Health Care, New Book Says

William Thomas Cain/Getty Images(WASHINGTON) -- During his 2008 presidential campaign and the fight for health care reform, President Obama often told the story of his mother Stanley Ann Dunham and how she spent the months before her death fighting with insurance companies who tried to deny her coverage based on a pre-existing condition.

That story is now being called into question by a new book which says Dunham in fact had health insurance when she died from ovarian cancer in 1995.

“My mother, when she got sick with ovarian cancer, she had just gotten a new job, and the insurance company was saying, ‘Well, maybe this is a pre-existing condition, so maybe we don't have to pay your medical bills.’ So I know what it's like to see a loved one suffer not just because they're sick, but because of a broken health care system. This is personal for me,” then-candidate Obama said at a March 2008 campaign event in Pennsylvania.

In A Singular Woman: The Untold Story of Barack Obama’s Mother, former New York Times reporter Janny Scott reveals that, although Obama claims Dunham was denied coverage because of a preexisting condition, she was actually only denied disability coverage.

The revelation is not being denied by the White House, The New York Times reported Thursday.

Dunham, an anthropologist, was working in Jakarta in 1994 when she began suffering from intense abdominal pains. At the time, she was working for the American company Development Alternatives, which provided her with health insurance.

An Indonesian doctor originally diagnosed Dunham with appendicitis and she debated going out of the country for an appendectomy. “‘You’ve got health insurance, that’s taken care of. We can cover the airfare. We can cover a few hundred dollars,'” Scott reports Dunham’s boss telling her at the time. Ultimately, Dunham stayed in Jakarta for the surgery.

In January 1995, an increasingly ill Dunham left Indonesia for Honolulu. Just days after her arrival, a gastroenterologist concluded her problem was not gastrointestinal and referred her to an oncologist who diagnosed her with third-stage uterine and ovarian cancer.

Shortly thereafter, she underwent a total hysterectomy and started a series of six monthly chemotherapy treatments. “In Honolulu, Ann pressed on gamely. According to her correspondence, Barry [Barack] helped her with insurance forms and letters in the immediate aftermath of her surgery,” Scott writes.

According to the book, however, Dunham’s insurance continued to cover her medical expenses when she was in Hawaii. “The hospital billed her insurance company directly, leaving Ann to pay only the deductible and any uncovered expenses, which, she said, came to several hundred dollars a month. To cover those charges as well as living expenses, she filed a separate claim under her employer’s disability insurance policy. That policy, however, contain a clause allowing the company to deny any claim related to a preexisting medical condition,” Scott explains.

CIGNA, Dunham’s insurer, investigated whether her cancer was a pre-existing condition and later denied her claim based on an earlier visit to a gynecologist. Dunham then informed CIGNA that she was turning the case over to “‘my son and attorney, Barack Obama.’"

Copyright 2011 ABC News Radio


Largest Medicare Fraud Case Ever Brought Against One Criminal Enterprise

Photo Courtesy - Getty Images(WASHINGTON) -- Seventy-three defendants, including a number of alleged members and associates of an Armenian-American organized crime enterprise, were charged in indictments unsealed Wednesday in five judicial districts with various health care fraud-related crimes involving more than $163 million in fraudulent billing, announced Acting Deputy Attorney General Gary G. Grindler, FBI Assistant Director of the Criminal Investigative Division Kevin Perkins and Health and Human Services Inspector General Daniel R. Levinson.

In this national, multi-agency investigation, 52 people were arrested Wednesday by FBI agents in the largest Medicare fraud scheme ever perpetrated by a single criminal enterprise and charged by the Department of Justice.

The defendants are charged with engaging in numerous fraud activities, including highly-organized, multi-million dollar schemes to defraud Medicare and insurance companies by submitting fraudulent bills for medically unnecessary treatments or treatments that were never performed.  According to the indictments, the defendants allegedly stole the identities of doctors and thousands of Medicare beneficiaries and operated at least 118 different phony clinics in 25 states for the purposes of submitting Medicare reimbursements.

“The emergence of international organized crime in domestic health care fraud schemes signals a dangerous expansion that poses a serious threat to consumers as these syndicates are willing to exploit almost any program, business or individual to earn an illegal profit,” said Acting Deputy Attorney General Gary G. Grinder. “The Department of Justice is confronting this evolving threat here and abroad through a number of initiatives including a strengthened Attorney General’s Organized Crime Council and the creation of the International Organized Crime Intelligence and Operations Center (IOC-2) to ensure that we are focused and coordinated in our efforts to combat international organized crime.”

“The international organized crime enterprise known as the Mirzoyan-Terdjanian, fleeced the health care system through a wide-range of money making criminal fraud schemes.  The members and associates located throughout the United States and in Armenia, perpetrated a large-scale, nationwide Medicare scam that fraudulently billed Medicare for more than $100 million of unnecessary medical treatments using a series of phantom clinics,” said Kevin Perkins, FBI Assistant Director of the Criminal Investigative Division.  “We want to restore the confidence in the nation’s health care system and assure practitioners we will not stand by and let their identities be used for criminal gain.”  

Copyright 2010 ABC News

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