 |
Health Care Fraud and Abuse Efforts ExpandHealth care fraud and abuse remains a top priority for both federal and state governments. Health insurance companies are also gearing up to combat health care fraud and abuse, and private “whistle blower” suits under the False Claims Act are on the rise. The “Physicians at Teaching Hospitals” or PATH Audit Program, continues to reap tens of millions of dollars in recovery. Currently, a number of teaching hospitals and medical schools are being audited to determine if Medicare Part B was billed for physician services actually provided by residents without proper supervision by attending physicians. Recent settlements include the University of Pittsburgh School of Medicine ($17 million), the University of Texas ($17.2 million), Yale University ($5.5 million), and Southern Illinois University ($600,000). The federal government is conducting an increasingly aggressive war on health care fraud and abuse. The Health Insurance Portability and Accountability Act (HIPAA), not only gave the federal government significant new legal weapons against health care fraud, but also made available sizable amounts of new funding from fraud recoveries to finance the expansion of anti-fraud efforts. The Office of Inspector General identified several areas of risk centered on professional billing. These areas of risk include:
|