A recent analysis of federal and state data by Reuters found that more than one-in-five of the physicians and other health care providers who have been banned from participating in Medicare nonetheless were able to bill state Medicaid programs: Reuters found 1,800 physicians and other health care providers who had been banned from the Medicare program were able to bill a state Medicaid program in 2014.
Reuters was able to obtain incomplete data from 32 U.S. states and the District of Columbia from which it found that the states (and D.C.) paid at least $79 million to 269 providers despite the providers having been banned from Medicare or other states’ Medicaid health care programs. Seventeen states have used Reuters’ analysis to go after 67 providers by terminating their Medicaid participation, by starting efforts to recover payments made to the providers, and/or by instituting investigations of the providers – the 67 providers had been paid a total of at least $874,000 while revoked.
Minnesota is actively attempting to recoup $548,000 from five providers who had been revoked from participating in the Medicare program.
Nevada is making efforts to recover $250,000 from revoked providers.
Georgia terminated an optometrist from participation in its Medicaid program on the same day that the optometrist pleaded guilty to defrauding Medicare (the optometrist allegedly billed Medicare for 177 eye exams that he claimed he performed in a single day). The optometrist is presently serving a 33-month sentence in federal prison. Despite the optometrist’s Medicare problems and termination from Georgia’s Medicaid program, he remained as a provider in South Carolina’s Medicaid program until South Carolina was contacted by Reuters.
A Philadelphia physician was able to remain an approved provider in Pennsylvania’s Medicaid program, due to alleged errors in data input, while he was serving a 51-month prison sentence arising out of allegedly receiving $263,000 in illegal payments for referring patients to a home hospice company (the Philadelphia physician received $17,000 from the Pennsylvania Medicaid program between the time of his guilty verdict and the time he began serving his sentence).
An Ohio provider of psychotherapy services pleaded no contest to felony workers’ compensation fraud in June 2011, after which he was revoked from the Medicare program and his Ohio medical license was permanently revoked in 2012. Despite his Ohio conviction and other problems, he continued to participate in the Illinois Medicaid program until February 2012, and Illinois failed to stop payments for services he provided through a company where he worked (Illinois did not terminate payment for his services from its Medicaid program until April 30, 2013 – Illinois’ Medicaid program paid $560,000 for services that he provided and prescriptions he wrote after he was revoked from Medicare).
If you have knowledge of Medicare fraud or Medicaid fraud that has cost the federal health care programs or state health care programs money and you become a whistleblower, your information and efforts in assisting the U.S. or a state to recover the illegal payments may entitle you to monetary compensation.
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