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Medicare/Medicaid Fraud Archives

Whistleblowing - How It Works, Why We Need It

Who are the most popular fraud targets? The U.S. and state governments. Why? Governments cannot possibly police each of their millions of transactions. But beware you Medicare false claimers, overcharging defense contractors, sales tax skimmers, and bill-padding construction contractors. An explosively growing army of honest employees await to blow the whistle on those illegally slicing your tax dollars into their own pockets. Host Bart Jackson invites noted qui tam (whistleblowing) super-attorney Andrea Fischer to reveal how upright citizens with an aggressive judiciary are bringing cheating firms to justice. Founder of the Fischer Legal Group, Andrea cites specific cases, describes the whistleblowing process and the retaliation protections. Tune in and learn about those valued individuals who refuse to tolerate corruption in our democracy. 

Former Bureau of Prisons employee settles Anti-Kickback Law case

"Improper financial arrangements between government officials and private contractors corrupt taxpayer-funded contracts," says the acting assistant attorney general of the Justice Department's Civil Division.

Whistleblower claim yields 6-state, $33-million fraud settlement

Seven years ago, two doctors stood up to powerful players in the emergency medical field by blowing the whistle on Medicare fraud. Their courage and hard work contributed to settlements of more than $33 million between two large physician groups and the Justice Department. As a result, the two whistleblowers will receive over $6.2 million.

Progressive units agree to $2 million False Claims Act settlement

A whistleblower will receive more than $600,000 after federal authorities obtained a $2 million+ settlement from Progressive Insurance in relation to alleged Medicare and Medicaid fraud. Progressive Casualty Insurance Co., of Cleveland, Ohio, and Progressive Garden State Insurance Co., of West Trenton, New Jersey, improperly submitted claims under the company's "health first" auto insurance policies.

Whistleblower: Clinics billed Medicaid for unlicensed treatment

A whistleblower has filed suit against a chain of Massachusetts mental health care centers, claiming the company defrauded the state and federal governments of $130 million. The accusation is that the company allowed "unlicensed, unqualified, and unsupervised employees" to treat patients. Doing so would be in clear violation of Medicaid regulations and requirements, the suit says.

New York doctors get prison for $100 million Medicare fraud

Three New York-based doctors will receive prison time after pleading guilty to accepting bribes. Their sentences are the most recent development in a massive scandal that involved $100 million in Medicare payments to a specific diagnostic lab. An extensive investigation by the Department of Justice has led to the conviction of over 30 physicians, including two from Staten Island and one from Yonkers.

Spotting fraud as a beneficiary

As a beneficiary of Medicare or Medicaid, you use these entitlements to pay for important medical bills or gain access to necessary prescriptions. Protecting the future of these programs remains a top social priority for many, but fraud continues to threaten resources. According to the Coalition Against Insurance Fraud, more than 2,500 people have been charged with Medicare fraud in the past decade, totaling nearly $8 billion in false claims.

NYC pharmacist accused of defrauding Medicaid of $11 million

A New York City pharmacist is facing both a civil complaint and criminal charges after allegedly bilking Medicaid out of $11 million. The pharmacist is accused of giving kickbacks to Medicaid patients in exchange for the opportunity to refill their prescriptions -- or to buy the prescriptions outright and bill Medicaid despite never intending to fill them. The patients were typically poor and the prescriptions were often for expensive HIV medications.

Justice Department forms first Health Care Fraud Unit

After last month's takedown of some 400 medical professionals accused of $1.3 billion in false billings, the Justice Department intends to remain vigilant in its fight against healthcare fraud. It has just announced the creation of the nation's first Health Care Fraud Unit to focus on issues like kickback schemes, upcoding and false diagnoses.

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