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SAVING GRACE |
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| PSYCHO-SOCIAL/ CULTURAL ISSUES |
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AGING WITH HUMOR |
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GOALS FOR SAVING GRACE |
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GRAY RIBBON CAMPAIGN |
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PROJECTS |
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ASSISTED LIVING |
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FRAUD AND ABUSE MEDICARE AND MEDICAID |
| Information on Medicare/Medicaid, Fraud and Abuse and News Updates |
| MEDICARE/MEDICAID INFORMATION |
NEARLY 8 CENTS
OUT OF EVERY DOLLAR PAID
BY MEDICARE LAST YEAR
WAS WASTED
"$13.5 Billion in Medicare Losses Reported
Inspector General Offers Offenders Leniency
March 10, 2000 WASHINGTON (AP) --
Medicare program losses -- money wasted
through fraud, mistakes and other problems --
inched up to $13.5 billion in
1999 after falling for three consecutive years,
government auditors
reported.
The figure means that nearly 8 cents
out of every dollar paid by Medicare
last year was wasted.
The program paid out $169.5 billion last year.
'We want to encourage providers to come
forward and disclose conduct that
threatens federal health-care programs,'
Brown said in a letter to
providers. A leniency program for those
who turn themselves in began in
1998."
PLEASE SEE "SAVING GRACE" WEB
PAGE ON
 "WHITE COLLAR CRIME"
ESSAY BY
ILA SWAN
WEST COAST EXECUTIVE DIRECTOR OF
ASSOCIATION FOR PROTECTION OF THE ELDERLY
AND NATIONALLY KNOWN ADVOCATE
QUOTED IN TIME MAGAZINE AND CBS NEWS
  Medicare Monitor: How a whistle-blower
spurred pricing case involving drug makers
Saturday, May 13, 2000
By DAVID S. CLOUD and LAURIE MCGINLEY
The Wall Street Journal (Via AP)
OR SEE ARCHIVES
"Ven-A-Care Inc., the little Key West company where
Mr. Bentley worked, bought the anti-cancer drug
to administer to patients in their homes.
He noticed that Ven-A-Care paid wholesalers
about $10 for a 50-milligram dose,
but Medicare reimbursed the company
$56 — for a hefty $46 profit.
Incredulous, he started looking into why."
Fraud: Taking Aim
Monday, March 20, 2000
By Jackie Jadrnak
Journal Staff Writer
OR SEE ARCHIVES
Monday, March 20, 2000
Fraud: Tips for Patients
Journal Staff Report
 THE OFFICIAL MEDICARE SITE
,MEDICARE FOR ALL
National Campaign to Protect, Improve
and Expand Medicare
HCFA
MEDICARE FRAUD
"Fraud is the intentional deception
or misrepresentation that an individual
knows to be false or does not believe
to be true and makes,
knowing that the deception could result
in some unauthorized benefit to himself/herself
or some other person.
The most frequent kind of fraud arises
from a false statement or misrepresentation made,
or caused to be made, that is material
to entitlement or payment under the Medicare program.
The violator may be a physician or other practitioner,
a supplier of durable medical equipment,
an employee of a physician or supplier,
a carrier employee, a billing service,
a beneficiary, or any other person or business entity
in a position to bill the Medicare program
or to otherwise benefit from such billing."
PSYCH CRIME
FRAUD
http://www.ktb.net/~psycrime/pc-fraud.htm
KEEP MEDICARE PUBLIC
GREAT SITE
Physician Financial Relationships With Others
http://www.netreach.net/~wmanning/finrel.htm
Sec. 1320a-7b. Criminal penalties for acts involving Federal health care programs
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Wednesday, February 19, 1997
Medicare and State Health Care Programs:
Fraud and Abuse; Issuance of Advisory Opinions by the OIG
AGENCY: Inspector
http://www.netreach.net/~wmanning/advopn.htm#back21
GREAT SITE
OIG INFORMATION
DEPARTMENT OF HEALTH AND HUMAN SERVICES
OFFICE OF INSPECTOR GENERAL
SIGN PETITION
MEDICARE FOR ALL
National Campaign to Protect, Improve
and Expand Medicare
CPT CODES
NURSING HOME COMPLIANCE
LONG TERM CARE.COM
Analyzing your Part B program for
compliance, double billing,
inappropriate private-pay charging!
'In the area of Nursing Home compliance...
Part B billing and it's relationship
to Part-A, private and Medicaid billing
is by far - the most concerning!'
COMPLIANCE
HCFA UPDATES
MEDICARE NEWSWIRE
FRAUD AND ABUSE
Special Fraud Alerts, Medicare Advisory Bulletins
and Special Advisory Bulletins
Department of Human Services
Medicare and Medicaid Fraud
PROTECTING THE GOVERNMENT’S INTERESTS:
QUI TAM ACTIONS UNDER THE FALSE CLAIMS ACT AND THE
GOVERNMENT’S RIGHT TO VETO SETTLEMENTS OF THOSE ACTIONS
MEDICAID MANAGED CARE
FRAUD AND ABUSE
OFFICE OF INSPECTOR GENERAL
Health Care Compliance:
A Physician’s Guide To Recent Enforcement Trends
(April 1998)
Thomas J. Kenny
Improving the Medicare Market: Adding Choice and Protections (1996)
ARKANSAS
MEDICAID FRAUD AND ABUSE DIVISION
Office of Attorney General
Includes Helpful Information
For All Persons
Interested in Medicare/Medicaid Abuse and Fraud
CENTER FOR MEDICARE ADVOCACY
Willimantic Connecticut
WHAT IS MEDICARE/MEDICAID ABUSE?
http://www.ag.state.ar.us/mfcu/whatis.htm
HOME PAGE
APPEAL SOLUTIONS
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|
 IN THE NEWS
Clinton budget boosts efforts to combat Medicare fraud
"Increased Medicare fraud-fighting efforts
could harm patients' access to care,
according to doctors.
Others say the government's
efforts are a paltry attempt to stem abuse."
By LaCrisha Butler,
AMNews staff.
Feb. 21, 2000. - Additional information.
AMERICAN MEDICAL NEWS
New panel gives doctors a say about
future Medicare benefits
Physician input is sought as HCFA
embarks on a new, more
public method for deciding which
innovative treatments will be covered.
By Susan J. Landers,
texnews.com
Medicare
Medicare Abuse
Friday, October 1, 1999
]
FOR MORE ARTICLES ON MEDICARE
AND MEDICARE/MEDICAID ABUSE SEE:
GO TO SEARCH
TYPE:
MEDICARE/MEDICAID
NURSING HOMES
ELDERLY ABUSE
OR TRY RELATED TOPICS
(Let "Saving Grace" grace@vcn.com
know of news that would interest
others on these topics).
Tex.News
Friday, October 1, 1999
Nursing home to lose Medicare, Medicaid payments
By JERRY DANIEL REED
Senior Staff Writer
WASHINGTON POST, Medicare Special Report
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| MEDICARE AND MEDICAID INFORMATION |
|
| BIBLIOPHILE FILE |
HEALTHCARE INTELLIGENCE NETWORK
Please See the article
Healthcare Industry/Managed Care:
Justice’s Big-Dollar Claim Against Vencor
is Bad News for Other Creditors
May 11, 2000
This article states:
"Among the specific alleged misdeeds are that Vencor"
billed Medicare individually for services provided in bunches.
For example, if Vencor or a subsidiary provided
portable X-ray services to five patients at a single
location at one time, the company would
charge five separate portage fees.
In some cases, two portage fees would be
charged for two X-rays of the same patient.
overbilled for dialysis services by
routinely drawing blood twice for a battery
of tests that only required a single draw.
folded costs incurred by its contract services
business into its long-term care hospitals,
increasing the cost-to-charge ratios
that determine Medicare disbursements.
"harvested" for resale drugs not used away
from the facility by long-term Medicare
patients for a day or more,
while still billing the patients.
kept patients in more-expensive hospitals
longer than necessary, for example by forbidding
discharges on Fridays to keep them over the weekend.
billed for a high level of care when
that care was not provided,
including charges for cardiac monitors without paper.
gave sales staff titles such as "case managers"
in order to bill Medicare for
sales calls to prospective patients.
required facility administrators to make
“increased Medicare utilization” a “tactical objective,”
through means such as offering paid holidays
and bonuses to medical workers.
The staff allegedly was trained to write medical orders
to show necessity for maximizing services.
Respiratory therapists were told to “comb the patient chart”
to find a reason to provide therapy;
if they couldn’t, the charts were changed.
falsified collection letters in order to
bill Medicare for bad debts.
held psychiatric patients unnecessarily
for the lifetime 180-day maximum,
guaranteeing the highest disbursement
but essentially preventing the person from
ever receiving inpatient treatment again.
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