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medicare and corporate
fraud
"Many national healthcare plans provide universal
insurance at a lower per-capita cost than the American system with better
results." - JD Hunley
"A jury might think $45 million is fair and just
compensation to the family of the woman who died while hospital personnel
ignored her cries of pain.
The judge will automatically reduce any
possible verdict to $250,000 - the most in non-economic damages anyone can
recover for any injury or death caused by a healthcare provider.
The
cap was passed at the behest of the insurance industry and medical
establishment more than three decades ago.
It has never been changed or
adjusted - even for inflation.
We may be reaching a point at which
letting patients die is more cost-effective than treating them." - Linda
Fermoyle Rice 1980s Under the
Reagan administration International Medical Centers run by George
Recarey expand rapidly due to a special exemption granted through the office of
Jeb Bush.
1987 A federal court jury finds Jorge
Recarey, Mariano Villa Del Rey and Antonio Fernandez Sr. guilty of labor
racketeering charges.
3 CONVICTED OF RACKETEERING
July
1994 National Medical Enterprises agreed to pay $379 million in
criminal fines, civil damages, and penalties for kickbacks and fraud at
National Medical Enterprises
psychiatric and
substance abuse hospitals in more than 30 states.
After this
settlement, National Medical Enterprises renames itself
"Tenet".
October 1996 First American Health
Care of Georgia, Inc, later Integrated Health Services, Inc, agrees
to reimburse the federal government $255 million for overbilling and making
fraudulent Medicare claims.
First American billed Medicare for
costs unrelated to the care of patients in their homes, including the personal
expenses of senior management, as well as marketing and lobbying expenses.
Epilogue: IHS files for
bankruptcy and never
pays the settlement.
November 1996 Laboratory
Corporation of America Holdings (LabCorp), agrees to pay $182 million to
resolve charges that it submitted false claims for medically unnecessary
laboratory tests to federal and state health care programs.
The fraud
involved bundled lab tests that were billed to Medicare as free-standing tests,
resulting in an eight-fold increase in charges to Medicare.
March 1997 SmithKline Beecham Clinical Laboratories
Inc. (SBCL), now GlaxoSmith
Kline, is ordered to pay $325 million for filing false claims involving
adding on laboratory tests not requested by doctors and not medically
necessary, billing for lab tests that were not actually performed, giving
kickbacks to doctors in order to get business, and billing Medicare for
dialysis testing already paid for by
kidney dialysis
centers.
July 1998 Blue Cross Blue Shield of
Illinois (also known as Health Care Service Corporation) pleeds
guilty to eight felony counts and agrees to pay $144 million.
The
nature of the fraud is that Blue Cross Blue Shield Illinois manipulated
work samples and falsified reports to the Health Care Finance
Administration in order to conceal evidence of its poor performance as a
federally contracted processor of Medicare claims.
January 2000 Fresenius Medical Care of North America,
the world's largest provider of kidney dialysis products and services, agreed
to pay a fine of $486 million for a scam involving National Medical Care,
Inc. (NMC), a kidney
dialysis subsidiary owned by Fresenius which included fraudulent and
fictitious blood testing claims by LifeChem, Inc. and fraudulent claims
submitted to Medicare for intradialytic parenteral nutrition (IDPN), a
nutritional therapy provided to patients during dialysis
treatments.
February 2000 Beverly Enterprises
Inc., the nation's largest assisted living facility chain, agreed to pay
$175 million to resolve civil and criminal charges that it defrauded Medicare
by fabricating Medicare patient records.
December
2000 HCA The Healthcare Company (formerly known as Columbia
HCA), the largest for-profit hospital chain in the US, pleeds guilty to
criminal conduct and agrees to pay more than $840 million in criminal fines,
civil penalties and damages for unlawful billing practices.
Fraud
included: billing for lab tests not medically necessary and not ordered by
physicians, "upcoding" medical problems in order to get higher reimbursements
for more serious medical issues, billing the government for advertising under
the guise of "community education," and billing the government for
non-reimbursable costs incurred in the purchase of health agencies around the
country.
This agreement does not resolve allegations that HCA
unlawfully charged for
the costs of running its hospitals, and that it paid kickbacks to physicians to
get Medicare and Medicaid patients
referred to its facilities.
March 2001 Vencor
Inc., one of the nation's largest assisted living facility chains, and
Ventas Inc., a related real estate investment trust, agreed to pay the
US $104.5 million to resolve claims for failure to provide the promised quality
of care to assisted living facility patients due to
inadequate staffing, improper care of
bedsores, and failure to meet resident's basic dietary needs.
October
2001 Taketa-Abbott Pharmaceutical Products Inc. agreed to pay
$875 million to resolve criminal charges and civil liabilities in connection
with fraudulent drug pricing and marketing of Lupron®, a drug sold for $500
per dose for the treatment of
prostate cancer under
Medicare Part-A.
2002 Pfizer paid $49 million to settle state and
federal Medicaid fraud charges involving
Lipitor®.
April 2003
Bayer paid $257,200,000 to settle Medicaid
fraud charges involving a "lick and stick" scheme in which Bayer sold
re-labeled products to an HMO at deeply discounted prices, and then concealed
this price discount in order to avoid paying additional rebates to the
government.
June 2003
AstraZeneca
agreed to pay $355,000,000 for providing free drug samples to doctors and
telling them to bill Medicare and Medicaid hundreds of dollars per
sample.
HCA agreed to pay $631 million in civil penalties and
damages arising from false claims, including cost report fraud and the payment
of kickbacks to physicians, submitted to Medicare and other federal health
programs.
July 2003 CG Nutritionals, Inc.
pled guilty to obstructing a criminal investigation and defrauding the Medicare
and Medicaid programs and agreed to pay $400 million to resolve civil claims.
In addition, the subsidiary of Abbott Labs, CG Nutritionals,
Inc., agreed to a criminal fine of $200 million in relation to the sale of
products which pump special foods into the stomachs and digestive systems of
patients who are not able to ingest meals in a normal manner.
2003 GlaxoSmithKline
signed a corporate
integrity agreement and paid $88 million in a civil fine for overcharging
Medicaid for the
antidepressant, Paxil®
and nasal allergy spray, Flonase®. |
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