A new policy from the Center for Medicare and Medicaid Services (CMS) targets healthcare providers who have a history of fraudulent billings. It would also prohibit providers that have Medicare debt from joining the program again. This measure could help save even more taxpayer dollars, since there are plenty of providers that face fraud allegations year after year.
Though the False Claims Act has been extremely effective in combating healthcare fraud, the fact that companies convicted of fraud can continue to participate in Medicare is a big issue. It’s all too easy for large insurance, pharmaceutical, and healthcare corporations to pay a fine and find new ways to cheat taxpayers and patients. Here are four of the major healthcare companies that have been repeatedly accused of Medicare & Medicaid.
1. Tenet Healthcare
In August 2016, Tenet agreed to pay $513 million to resolve kickback allegations. The company had faced a False Claims Act lawsuit and was accused of violating the Anti-Kickback Statute. According to the lawsuit, Tenet hospitals paid kickbacks to a prenatal facility in exchange for patient referrals. Tenet hid the scheme by misclassifying the services as translation fees and other legitimate-sounding payments.
This is hardly the first time the hospital has dealt with serious legal problems. Tenet has been sued repeatedly over the last 20 years. After the initial rash of lawsuits, the company appeared to strengthen its compliance program. Oddly enough, it then committed one of the biggest healthcare fraud schemes to date, eventually paying back nearly a billion defrauded dollars to the federal government.
2. Universal Health Services
Though healthcare fraud is almost always about money, patients can easily get caught in the crosshairs of corporate greed. The ongoing scrutiny of UHS facilities is a tragic example of what can happen when healthcare companies put their profits before their patients.
According to civil and criminal investigations, 10% of UHS hospitals may be admitting mental healthcare patients regardless of their eligibility. Some patients report having been drugged and forced to check into UHS facilities, despite the fact that they were not a danger to themselves or others. Over 2,800 reports have been filed accusing UHS of fraud and patient abuse, including accusations of physical abuse of patients.
Humana, a major insurance company that offers Medicare advantage plans, has been accused of upcoding and other billing violations more than once. Its legal woes started in the ‘90’s, when class action lawsuits accused the company of bribing doctors to go against their patients’ best interest.
Humana was sued several times from then onward, most recently due claims of Medicare Advantage fraud. The insurance company allegedly knew that some of its South Florida clinics were upcoding, but chose not to report that information to the government. The allegations came to light when a Florida doctor, Mario Baez, filed a whistleblower lawsuit on behalf of the federal government.
4. Adventist Health System
Adventist is one of the biggest healthcare systems in the country, and since 2000 has had to pay over $150 million in settlements to resolve fraud allegations. In September 2015, the company paid $118.7 million to settle a whistleblower lawsuit. The lawsuit alleged that the company submitted false claims and used taxpayer funding to pay for cars and other luxuries.
Adventist also allegedly violated physician self-referral laws, which prohibits doctors from referring patients to any service or facility in which they have a financial stake. Unfortunately, the company was not required to enter into a Corporate Integrity Agreement as part of its settlement, so only time will tell whether Adventist tries to cheat the system again.
Righting Corporate Wrongs
Though these four healthcare companies have had a particularly long history of fraud, they are just the tip of the iceberg when it comes to False Claims Act violations in the healthcare industry. Multibillion dollar corporations often have the means to skirt responsibility, even when they are wasting taxpayer funding and hurting patients. That’s why healthcare workers who witness fraud have the legal right to blow the whistle on their employers. Learn more about whistleblower rights for healthcare workers here.