Healthcare fraud costs Americans as much as $300 billion a year. But uncovering fraud in a healthcare system as sprawling and complex as ours—Medicare alone processes over 1 billion claims annually from over 1 million providers—is like digging for needles in a breathtakingly huge haystack. That's why the federal government relies heavily on the False Claims Act’s qui tam provisions to encourage ordinary people to blow the whistle on fraud by filing private civil lawsuits. False Claims Act … [Read more...]
Supreme Court Strikes Blow in Favor of Whistleblowers
In May, we wrote about how U.S. Supreme Court Justice Antonin Scalia’s death might impact a key whistleblower case brought under the False Claims Act. It turns out that Justice Scalia’s presence might not have made much of a difference: The eight remaining Justices came through with a significant—and unanimous—victory for whistleblower plaintiffs, and delivered a strong rebuke to government contractors that would defraud taxpayers through misleading omissions and then evade responsibility by … [Read more...]
Switch to ICD-10 Not A Cure-All For Healthcare Fraud
The World Health Organization is the public health arm of the United Nations. Since 1948, WHO has been responsible for updating the International Classification of Diseases (ICD), a worldwide system for collecting, processing, classifying and processing statistics about diseases. The most recent version of the ICD is ICD-10, or tenth edition, which WHO published in 1999. The U.S. Center for National Health Statistics adapts the ICD to create the ICD-CM, which is used by U.S.-based healthcare … [Read more...]
Inspector General Report Provides Strong Clues on Trends in Healthcare Fraud
The U.S. Department of Health and Human Services (HHS) is the federal agency that runs the Medicare and Medicaid programs. Within the Department, the Office of the Inspector General (OIG) is charged with preventing fraud on the Medicare and Medicaid programs, and identifying and holding accountable those that have abused their role as healthcare providers. OIG conducts audits, investigations, and evaluations of Medicare and Medicaid, and works closely with attorneys within HHS and at the U.S. … [Read more...]