FBI: $4.1 Billion Recovery From Medicare Overpayment & Healthcare Fraud

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ERISAclaim.com Offers New Webinars To Discuss The FBI Press Release On Feb 14, 2012, That Nearly $4.1 Billion Was Recovered, As The “Largest Sum Ever Recovered In Single Year”, From Medicare Overpayment And Healthcare Fraud. What Does $4.1 Billion Recovery Mean to All Non-Medicare Providers?

So this Medicare anti-fraud news is for everyone who will never even deal with Medicare claims.

ERISAclaim.com offers new healthcare executive webinars to discuss the FBI Press Release On Feb 14, 2012, that nearly $4.1 billion was recovered, as the “largest sum ever recovered in single year”, from Medicare overpayment and healthcare fraud. The Webinar will also assess what this $4.1 billion recovery means to all non-Medicare providers, as the private industry has been always following the Medicare footsteps in healthcare claims processing and overpayment recovery for criminal, civil fraud, and non-fraudulent but “otherwise improperly obtained” overpayment from non-Medicare health plans.

“It is very important to know that nowadays the federal governmental agencies also unprecedentedly investigate and prosecute anyone for alleged healthcare fraud for non-Medicare health plans. So this Medicare anti-fraud news is for everyone who will never even deal with Medicare claims,” said Dr. Jin Zhou, President of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance.

“Many healthcare fraud investigations start with alleged overpayment, and more and more overpayment demand from payers in private sector imply or allege healthcare fraud while providers are completely clueless or careless,” explained Dr. Zhou.

According the FBI National Press Releases on Feb. 14, 2012, “Health Care Fraud Prevention and Enforcement Efforts Result in Record-Breaking Recoveries Totaling Nearly $4.1 Billion, Largest Sum Ever Recovered in Single Year” (http://www.fbi.gov/news/pressrel/press-releases/health-care-fraud-prevention-and-enforcement-efforts-result-in-record-breaking-recoveries-totaling-nearly-4.1-billion):

“WASHINGTON—Attorney General Eric Holder and Department of Health and Human Services (HHS) Secretary Kathleen Sebelius today released a new report showing that the government’s health care fraud prevention and enforcement efforts recovered nearly $4.1 billion in taxpayer dollars in fiscal year (FY) 2011. This is the highest annual amount ever recovered from individuals and companies who attempted to defraud seniors and taxpayers or who sought payments to which they were not entitled.”

“Approximately $4.1 billion stolen or otherwise improperly obtained from federal health care programs was recovered and returned to the Medicare Trust Funds, the Treasury and others in FY 2011. This is an unprecedented achievement for HCFAC, a joint effort of the two departments to coordinate federal, state and local law enforcement activities to fight health care fraud and abuse.”

“While word “stolen” would mean for career criminals, “otherwise improperly obtained” could mean for “unprecedented” medical necessity fraud, billing & coding fraud, documentation fraud or marketing fraud, the kinds of the fraud that will be unprecedentedly faced by every healthcare provider, knowingly or unknowingly,” commented Dr. Zhou.

The FBI Press Releases on Feb 14, 2012 also illustrated the epidemic seriousness of the unprecedented healthcare fraud investigation and convictions:

“In FY 2011, the total number of cities with strike force prosecution teams was increased to nine, all of which have teams of investigators and prosecutors from the Justice Department, the FBI and the HHS Office of Inspector General, dedicated to fighting fraud. The strike force teams use advanced data analysis techniques to identify high-billing levels in health care fraud hot spots so that interagency teams can target emerging or migrating schemes along with chronic fraud by criminals masquerading as health care providers or suppliers. In FY 2011, strike force operations charged a record number of 323 defendants, who allegedly collectively billed the Medicare program more than $1 billion. Strike force teams secured 172 guilty pleas, convicted 26 defendants at trial and sentenced 175 defendants to prison. The average prison sentence in strike force cases in FY 2011 was more than 47 months.”

Last year, HHS OIG published a website, titled: “HEAT Provider Compliance Training: Health Care Fraud Prevention and Enforcement Action Team Provider Compliance Training”, for all healthcare providers and billing industry to be self educated proactively and voluntarily, in order to prevent any unintended violations, added Dr. Zhou. (http://oig.hhs.gov/compliance/provider-compliance-training/index.asp)

Unless in pure criminal and civil fraud cases, overpayment demand from payers in the private industry frequently imply or allege borderline fraud or questionable practice, according to Dr. Zhou.

The new ERISAclaim.com Executive Webinar will discuss the following topics:

1.    Executive Brainstorming on the FBI National Press Releases on Feb. 14, 2012.
2.    OIG, HEAT Provider Compliance Training: Health Care Fraud Prevention and Enforcement Action Team Provider Compliance Training (http://oig.hhs.gov/compliance/provider-compliance-training/index.asp)
3.    OIG: “The Seven Fundamental Elements of an Effective Compliance Program”
4.    OIG: “Five Practical Tips for Creating A Culture of Compliance”
5.    Fraud and abuse prevention programs to avoid criminal, civil fraud allegation
6.    Overpayment demand as an adverse benefits determination v. Pure fraud investigation.
7.    Medicare Appeal regulations (http://www.cms.gov/OrgMedFFSAppeals/) & (http://www.cms.gov/MMCAG/)
8.    PPACA & ERISA Appeal Regulations (http://www.dol.gov/ebsa/healthreform/)

To find out more about PPACA Claims and Appeals Compliance Services from ERISAclaim.com:

Located in a Chicago suburb in Illinois, ERISAclaim.com offers free webinars, basic and advanced educational seminars and on-site claims specialist certification programs for doctors, hospitals and commercial companies, as well as numerous pending national ERISA class action litigation support. Dr. Jin Zhou is regarded as the industry “Godfather of ERISA claims” for healthcare providers.

For any questions, please contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.


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