Readers of this blog know that scammers are routinely bilking the federal Medicare system out of large sums of money, crimes that add up to billions (yes, with a “b”) in losses every year. Health care fraud is not, however, only a federal matter. From small lies to big ones,…
Medicare billing is a complex and specialized field. Translating patient care into billing codes takes knowledge and skill. While most providers and coders work hard to make sure billing codes accurately reflect the care provided, others use the system to divert money from government coffers into their own pockets. Fraudulent…
It seems like you can barely turn on the television these days without seeing an advertisement for medications and medical equipment. Equipment ads in particular often target seniors and inevitably include a promise that the company will deal directly with Medicare to get the product supplied with little or no…
Medicare Advantage (“MA”) plans allow Medicare beneficiaries to have a private company manage their health care benefits. When a beneficiary opts for coverage via an MA plan, Medicare pays the plan a set amount depending on the patient’s health status. As detailed below, this capitated payment system relies upon providers…
There has been growing awareness in recent years about the importance of mental health. More people are seeking help and health professionals are becoming more educated on the importance of a well-rounded definition of health. Sadly, there are also scammers out to take advantage of this trend including the perpetrators…
Regular visitors to this blog are familiar with the False Claims Act (“FCA” or “the Act”), a piece of federal law aimed at recovering money wrongfully taken from government coffers. The Act contains detailed provisions that allow ordinary private citizens to bring suit on the government’s behalf through a process…
It takes a very special individual to work in the end-of-life care arena. We have the deepest respect for the men and women who support both patients and their loved ones in the hospice care environment. These professionals offer much more than medical care, they offer emotional support to people…
Choosing a nursing home or other senior care facility is a difficult and emotional decision. There are many factors to consider, many of which can spark intense family debates, including location, price, and available forms of care. There are also more individualized factors like whether the prospective resident has friends…
Earlier this month we wrote about the theft of prescription drugs, focusing on the growing problem of medications being stolen from our nation’s seniors and why drug theft is a form of elder abuse. We urge all readers to ensure their own medications and those of loved ones are kept…
Kickbacks to physicians are one of the most concerning forms of Medicare fraud. Why? Kickbacks to doctors create mixed incentives. Instead of being guided by concerns for their patient’s welfare, the doctors may be tempted to make choices, from seemingly innocuously ones to which lab to use to run a…