Archive for the ‘Fraud’ Category

NEJM- Caught Covering Up for National Kidney Foundation–an indudstry front group | AHRP

Tuesday, January 10, 2017 | By William Tinker | No Comments

Readers of the New England Journal of Medicine should be forewarned:  The information in the pages of the NEJM is tainted by industry influence, its professional and scientific integrity are t…

Source: NEJM- Caught Covering Up for National Kidney Foundation–an indudstry front group | AHRP

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CMS examines inappropriate steering of people eligible for Medicare or Medicaid into Marketplace plans

Wednesday, September 14, 2016 | By William Tinker | No Comments

The Centers for Medicare & Medicaid Services (CMS) today issued a request for information seeking public comment on concerns that some health care providers and provider-affiliated organizations may be steering people eligible for, or receiving, Medicare and/or Medicaid benefits into Affordable Care Act-compliant individual market plans, including Health Insurance Marketplace plans, for the purpose of obtaining higher reimbursement rates. Go here for the whole story. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-08-18-2.html

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Dialysis Providers Pay Out Over $2 Billion in Settlements

Tuesday, September 13, 2016 | By William Tinker | No Comments

It will probably come as no surprise that most of the major renal care facilities in the US have come under investigation for fraud in recent years, including Fresenius Medical Care America, DaVita Inc. Renal Care Group, Quest Diagnostics, and Bone Care International.

A partial list of settlements paid since 2000

 

Fresenius $250 million Granuflo heart problems and deaths 2016
$82 million Unauthorized claims for Renal care 2011
$19 million Billing for unqualified home dialysis 2010
$486 million Billing fraud, unnecessary labs, kickbacks 2000
DaVita $450 million Wasting medicine to collect the markup/profit 2015
$400 million Kickbacks in exchange for patient referrals 2014
DaVita/Gambro $37 million Kickbacks, unnecessary tests, overbilling 2005
DaVita/Gambro $325 million Kickbacks, overbilling 2004
DaVita/Gambro $53 million Medically unnecessary lab test 2000

 

 

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UnitedHealthcare Sues Dialysis Chain Over Billing – The New York Times

Monday, July 4, 2016 | By William Tinker | No Comments

The suit accuses the chain of pushing patients out of government programs and into UnitedHealthcare plans, which pay more for dialysis treatment.

Source: UnitedHealthcare Sues Dialysis Chain Over Billing – The New York Times

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Justice Department investigating DaVita subsidiary

Wednesday, December 16, 2015 | By William Tinker | No Comments

A recent Modern Healthcare website article by Lisa Schencker and Sabriya Rice deals with the ongoing investigation by the Justice Department of a DaVita Health Care subsidiary.

The False Claims Act investigation centers on the medical necessity of the procedures performed at two Florida centers that are part of RMS Lifeline, a DaVita subsidiary that provides vascular access management services for dialysis patients, according to the filing. The Justice Department has asked for medical records for 10 patients, among other documents, from January of 2008 through the present.
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Davita Whistle Blower Meets with Dialysis Advocates

Wednesday, December 3, 2014 | By William Tinker | No Comments

IMG_4930David Barbetta the successful whistle blower against DaVita HealthCare Partners Inc. recently had lunch with Arlene Mullin Director of Advocating at Dialysis Advocates. During there lunch David pledge to help with the ongoing struggle to bring change in the training of dialysis technicians and the overall patient experience with clinics. Due to his courage and generosity we will be able to increase our push for change.

Dialysis Advocates has a long history of fighting for patient rights and holding clinics and doctors responsible for treating patient with dignity and respect.

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DaVita Finalizes $400M Settlement Over Kickback Claims

Thursday, October 23, 2014 | By William Tinker | No Comments

By Kurt Orzeck

Law360, Los Angeles (October 22, 2014, 9:48 PM ET) — Dialysis giant DaVita HealthCare Partners Inc. has finalized a deal in which it will pay $389 million and unwind 11 joint ventures to resolve criminal and civil claims by a whistleblower that it provided kickbacks to kidney doctors, DaVita and the U.S. Department of Justice said Wednesday.

Denver, Colorado-based DaVita agreed to pay $350 million to settle criminal allegations that it violated the False Claims Act through so-called partial divestitures to nephrologists, and to pay a $39 million civil forfeiture stemming from two specific joint venture transactions DaVita entered into in Denver, according to the DOJ.

Continue reading “DaVita Finalizes $400M Settlement Over Kickback Claims” »

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Listen to our radio show with Dearly Departed Dialysis Patients Families on the problems of care of their loved ones.

Tuesday, September 2, 2014 | By arlene | No Comments

A frank discussion with family members of departed Dialysis Patients about the level of care provided to their loved one. Additionally the feeling of a lack of basic information on the care of the family member and how they felt out of the loop during the Dialysis process and care for their loved one will be covered.

The current problem with overworked and under trained technician’s which has led to patient injury and in some cases patient deaths needs to be addressed and changes legislated.

There are too many cases of patients being terminated from care for unjust causes; then blackballed from care by other clinics within the same company.

Listen on line at: http://www.blogtalkradio.com/dialysisadvocates/2014/09/05/dialysis-talk

To listen by phone or participate call (347) 857-3961

Thursday evening September 4, 2014

9:00 Eastern, 8:00 Central, 6:00 Pacific

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DaVita sets aside more contingency funds

Monday, November 11, 2013 | By Scott | No Comments

The Denver Post – 11/05/2013

Dialysis giant DaVita HealthCare Partners has set aside an additional $97 million on top of $300 million the company put in a contingency fund this year to settle criminal and civil anti-kickback investigations.

Read more

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Fraudulent Ambulance Billing To Medicare

Tuesday, October 29, 2013 | By Scott | No Comments

Here is a brief description of the type of ambulance fraud we have been seeing.

Medicare will pay for emergency and non-emergency ambulance services only when a beneficiary’s medical condition at the time of transport is such that other means of transportation, such as taxi, private car, wheelchair van or other type of vehicle is contraindicated (i.e. would endanger the beneficiary’s medical condition).  Medicare does not cover any means of transport other than transport by ambulance.

Non-emergency transportation by ambulance is appropriate and covered only when a patient is bed-confined and his/her condition is such that transportation by ambulance is medically required.  Medicare defines bed confinement as: unable to get up from bed without assistance; unable to ambulate;  and, be unable to sit in a chair or wheelchair.

Much of the income for many ambulance companies is generated by providing non-emergency ambulance transport to Medicare recipients to medical centers, such as dialysis clinics.

The companies transport patients who could walk or be transported by other means (i.e., taxi or paratransit van), falsely representing to Medicare that these patients medically required transportation by ambulance.  For example, patients are directed to get onto a stretcher or were placed onto a stretcher by ambulance company employees, when the patients were able to walk or to be moved by wheelchair.  Alternatively, some patients simply walk to and from the ambulance.  This also permits the ambulance company to transport 2-5 patients at once in the ambulance, rather than just one patient on a stretcher. 

The ambulance company then bills Medicare for the transport of these patients by ambulance, claiming it was a medical necessity.  The majority of dialysis patients need to attend dialysis treatments three times per week, thereby allowing the ambulance company to bill extensively for these patients.  For a round-trip transport, Medicare can pay between $400-800 per person depending on the area of the country and the patient’s needs. 

Kickbacks may be involved in this process:

  1. KBs from ambulance company to dialysis clinic employees who recruit, solicit or identify potential patients for the ambulance company.  Dialysis clinic employees, esp. admissions staff, often see the patients walking, etc. from the ambulance and know which ones are complicit in the fraud.
  2. KBS to physicians who will sign a certificate claiming that a patient requires transport due to a medical necessity.
  3. KBs to the patients themselves who are supposed to receive ambulance transport and do not need it.  Patients are often paid “signing bonuses” for agreeing to be transported by an ambulance company, or from switching from one company to the next.  There is considerable competition between ambulance companies for these patients.

Damages from these cases can range from the six figures up to $5-10 million depending on the size of the company.

 

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