Posts Tagged ‘Medicare fraud’

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.

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.

 

Letter: Don’t cut Medicare funds for dialysis – Wausau Daily Herald

Wednesday, October 2, 2013 | By Scott | No Comments

This is and excerpt from a letter written by an assistant facility administrator operated by DaVita in Wausau, WI.

…Medicare plays a central role in the kidney care community, and even more cuts could be devastating. Under the newly proposed rule, Medicare reimbursements would decrease from $246.57 per three- to four-hour dialysis session to only $216 for the same treatment.

A $30 reduction may not seem like much, but these proposed cuts would decrease reimbursements well below the cost of care. Considering that those on dialysis require multiple treatments per week, $30 less per session is a substantial cut that could force facilities to consolidate services, reduce staff, trim operating hours, or in some cases close.

…Medicare’s End Stage Renal Disease program has served as a model for excellent care and we hope readers will contact Sens. Tammy Baldwin and Ron Johnson to ask for their support as well.

ON THE OTHER HAND

DaVita profits were $478,000,000 in 2012, up 17.8% over 2011.

Additionally, DaVita HealthCare has had to fork over more than $350 million over the past year to settle various fraud cases. Nevertheless, CEO Kent Thiry made the top 25 highest-paid list in 2012 with more than $26 million in total compensation.

Our government continues to pay a company who is guilty of fraud with our tax dollars.

Is anyone else out there scratching their heads?

DAVITA POSSIBLE FRAUD WITH IRON CNN ANDERSON COOPER

Tuesday, December 4, 2012 | By arlene | No Comments

A company that runs 2.000 dialysis clinics in the U.S. is accused of making hundreds of millions through Medicare fraud.

VIEW CNN VIDEO

DAVITA FROM CNN 360

Tuesday, December 4, 2012 | By arlene | No Comments

Dialysis company accused of giant Medicare fraud.

Read more and see the video on CNN

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Dialysis Senate Subcommittee – 2000 hearing. Arlene Mullen Testimony

Monday, September 24, 2012 | By Scott | 1 Comment

Thank you for this opportunity to be heard. The foregoing testimony represents how End Stage Renal Disease and Kidney Dialysis has evolved into a National Use and Abuse of Medicare Dollars and Dialysis Patients. This National Abuse frequently includes unreported patient deaths that are not related to their chronic disease, but to unethical and immoral practices of facilities.

Like so many others in the dialysis field, I was just a healthcare worker who received “on the job” training. I am not licensed or registered with any state or healthcare organization. I had direct and complete hands on care responsibilities for patients including inserting needles into their veins or graft in order to connect them to their dialysis machine to initiate their lengthy treatment. I, like many others at this level, did not have a comprehensive understanding of the renal diseases and process, the psychosocial problems, and most of all, the dangers of the equipment used and problems associated with the chemicals used in the reprocessing of dialyzers.

After months and months of witnessing the improper use of equipment, supplies, drugs and above all watching licensed professionals to permit these acts to proceed at the cost of the patients health and welfare brought numerous concerns. I followed the chain of command with no results. My conscience would not let me be silent and I filed my complaints with the Region 10 HCFA Office, which violated my confidentiality, and advised the Renal Network to handle my complaint that ironically was about them. I did file a formal complaint with the State Department of Health in which the investigation discovered that the State does not regulate End Stage Renal Disease Facilities and, therefore, could not impose sanctions. Continue reading “Dialysis Senate Subcommittee – 2000 hearing. Arlene Mullen Testimony” »