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Topic: False billing

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False Claims Law

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In the News (Sun 15 Nov 09)

Northern Trust

Marvin Harrison

Peter Chernin

Gary Locke

Match Play

Penelope Cruz

Mickey Rourke

AR Rahman

Danny Boyle

Hugh Jackman

	False Alarm Software used by Alachua County and the City of Gainesville, FL
		According to a report by a coalition of alarm industry sponsors and the International Association of Chiefs of Police, 80 percent of false alarms are triggered by 20 percent of the alarm users, and the major source of false activations is user error.
		But while ordinances have been proven to be effective in reducing false alarms calls, many agencies are finding it impossible to properly enforce the ordinances because they lack the ability to track repeat offenders and bill them.
		The computer (False Alarm Reduction System) tracks alarm call responses received through the Computer Assisted Dispatch or CAD system, and also the citations for false alarms issued under both county and city ordinances.
	www.falsealarmreduction.com /AlachuaCountyNews.htm (830 words)

	Qui tam, Healthcare Fraud, Medicare Fraud - Nolan Law Firm
		Healthcare fraud False Claim Act cases, include coding false claims, DRG false claims fraud, PPS false claims fraud, Medicare kickbacks, outpatient PPS false claims fraud, Stark law violations, DME fraud and DRG fraud, are brought by whistleblowers, often those who have attempted to call attention to the problem within their company.
		Billing for medically unnecessary services - this includes furnishing services in excess of the patient's needs, based on their diagnosis, or furnishing a battery of diagnostic tests, where, based on the diagnosis, only a few were needed; it also includes misrepresenting the diagnosis to justify the services or products.
		In general, coding false claims, DRG false claims, PPS false claims, outpatient PPS false claims, kickback, Stark law violations, DME fraud, and DRG fraud (DRG creep) may be uncovered by people with knowledge of the requirements of the government programs involved and the misrepresentations made by the companies engaging in the conduct.
	www.whistleblowerfirm.com /falseclaim.html (1181 words)

	All-about-qui-tam.org - The False Claims Act - Common types of fraud - Health care fraud
		Billing Medicare and Medicaid for medical services is done using a complex system of numerical codes that designate various diagnoses and procedures.
		The coded, computerized bills submitted by providers are processed by large insurance companies (known as "intermediaries") that contract with the government to pay claims using government funds.
		His Medicaid billings went from $8,200 to more than $2.2 million in two years and involved huge kickbacks to more than 50 so-called "salesmen." He was excluded from Medicare and state health care programs for 10 years and sentenced to one to three years in prison.
	www.all-about-qui-tam.org /fca_health.shtml (2621 words)

	SELECTED CASES
		The purpose of creating the false bills was to meet the state tort threshold of $2,000 in medical expenses, a threshold required before damages for pain and suffering can be sought.
		He falsely billed the insurance companies for examinations, physiotherapy sessions and medical equipment that he never provided to the patients and certified to insurance companies that he personally administered all physiotherapy to patients, when in fact the therapy was either unsupervised or was provided by untrained clerical personnel.
		A chiropractor, with high billing rates, and his wife were convicted of numerous counts of mail fraud involving the padding of bills in the treatment of victims of automobile accidents.
	www.usdoj.gov /opa/health/hcf2.htm (9539 words)

	CryWolf - False Alarm Reduction, Billing and Management Software
		A false alarm is defined as an alarm signal activation where no physical evidence of a crime is found.
		The causes for these false alarms are most often accidental, and they not only affect the police, but impact the alarm owner financially in the form of false alarm fines.
		False alarms are expensive and impact public safety as a whole.
	www.crywolf.us (311 words)

	False Alarm News
		The False Alarm Billing (FAB) program has the ability to handle situations such as a waiver of an alarm months after an appeal process is completed through the city by the alarm owner.
		Another example addressed is an alarm address where the tenant has moved and the new tenant has also installed an alarm, and the previous tenant’s balance remains.
		The company also sends the consultant back for the first two month’s billing cycles to insure the system is implemented properly and the municipal staff is trained properly.
	www.falsealarmsoftware.com /news1.htm (426 words)

	Renton Dentist Sentenced in Medicaid False Billing Case (Site not responding. Last check: 2007-10-09)
		In November, the Attorney General's Medicaid Fraud Control Unit filed one count of first-degree theft and one count of Medicaid false statement against Lee after an audit by the state Department of Social and Health Services' Medical Assistance Administration revealed the false billing.
		The audit and followup investigation by the Medicaid Fraud Control Unit found that Dr. Lee billed the Medicaid program for approximately $175,000 worth of services that either were not provided, or for which there was inadequate documentation.
		The improper billings occurred between 1998 and 2002.
	www.atg.wa.gov /releases/rel_lee_010904.html (170 words)

	Health care Medicare fraud, pharmaceutical fraud, unbundling, upcoding examples
		Billing for unnecessary procedures or services that have been added to a bill for legitimate charges is another type of false claim.
		The lawsuit charged the company billed Medicare for blood tests added to the standard panel of blood chemistry tests even though doctors had not ordered the extra tests and they were medically unnecessary.
		The coded, computerized bills submitted by providers are processed by large insurance companies (known as "intermediaries" or "carriers.") that contract with the government to pay claims using government funds.
	www.phillipsandcohen.com /CM/FalseClaimsAct/cmtyph_f.asp (3178 words)

	Sharon optometrist admits false billing - The Boston Globe
		Sharon optometrist admits false billing - The Boston Globe
		A Sharon optometrist was sentenced yesterday to three years in jail after pleading guilty to falsely billing insurance companies for procedures he never conducted.
		Harvey G. Schneider, 60, who practiced out of Concord and Randolph offices, admitted he received about $373,000 from insurance companies fraudulently by billing them for medical tests and other services he did not provide from 1996 to 2002, according to Attorney General Thomas F. Reilly's office.
	www.boston.com /news/local/maine/articles/2004/10/20/sharon_optometrist_admits_false_billing (728 words)

	[No title]
		Whether the materiality of false statements under 42 U.S.C. 1396h(a)(1) is a question of law to be decided by the court.
		Thus, it was clear from the context, if not from the contents of billing code 90040 standing alone, that an injection should be billed as a "(m)inimal service," not as a "(b)rief examination, evaluation, and/or treatment." Second, the evidence was clear that petitioners were on notice that injections did not fall under billing code 90040.
		21), their use of billing code 90040 was not merely "not responsive to the question asked and arguably misleading by negative implication." Rather, the jury found that they knowingly and intentionally used a false billing code in an affirmative act of deception designed to generate increased payments by HMSA.
	www.usdoj.gov /osg/briefs/1987/sg870252.txt (1534 words)

	Purvis Gray Technology Group LLC (Site not responding. Last check: 2007-10-09)
		False alarm reduction should be a cooperative effort among all parties involved.
		Purvis Gray Technology Group's False Alarm Reduction System (FARS) is a premiere billing system that offers agencies the capability to track and bill permit registrations and violators of false alarm ordinances.
		In Alachua County, Florida, the sheriff 's department has seen a 56 percent reduction in false alarms since the adoption of a model ordinance in 2000.
	www.purvisgray.com /tech/falsealarm.asp (390 words)

	Health Care Professional Information Center: Federal Court Reinstates Qui Tam Action Alleging Improper Billing of ...
		The action alleged that the false claims involved the billing of Medicare for services rendered by non-physicians without a physician present as if they were rendered "incident to the service of a physician," even though the clinics knew the services did not meet the criteria of physician supervision necessary for billing in that manner.
		Cox said provisions from the Medicare Carrier's Manual, Medicare bulletins, and expert testimony regarding the proper billing of incidental services could provide the basis for Walker's claim that R and F understood the language of the regulation to mean that a physician had to be physically present in order to bill for incidental services.
		In addition, four months before Walker filed the whistleblower action, 42 CFR §410.26 was amended to require that all services billed as "incident to the services of a physician" be rendered under the "direct supervision" of a physician.
	healthcenter.bna.com /pic2/hc.nsf/id/BNAP-6KSLP7?OpenDocument&PrintVersion=Yes (434 words)

	Whistleblower Laws
		False Claims Act litigation, also known as Qui Tam litigation, is different from ordinary civil litigation in several ways specifically governed by the Act's unique provisions.
		Under the False Claims Act, a person who blows the whistle is known as the qui tam "relator." Qui tam litigation under the False Claims Act also varies from cases in which only the Government prosecutes the fraudulent contractor.
		The False Claims Act allows a case to be brought in any federal court district in which one or more defendants can be found, resides, transacts business or in which any actions giving rise to the false claim occurred.
	whistleblowerlaws.com /law.htm (2831 words)

	Qui Tam - Taxpayers Against Fraud - False Claims Act Legal Center
		The False Claims Act is not used to correct minor billing mistakes or errors, as these frauds are not systematic and rarely amount to truly large sums of money.
		Under the bill, which may be voted on as early as this evening, states that pass their own False Claims Acts will see a 10 percent increase in the amount of money they can keep when a Medicaid False Claims Act case is resolved.
		A False Claims Act lawsuit against Swiss-based Serono for the marketing of their Serostim human growth hormone was settled for $704 million, making it the largest civil prescription drug settlement to date.
	www.taf.org /home.htm (5238 words)

	FY 2004 FCA Fraud Settlements
		Overbilling, retroactive billing, billing work performed by interns as if it was performed by doctors.
		False billing for home health care visits that were deemed unnecessary or unreasonable.
		Submitted false and fraudulent claims to the Department of Housing and Urban Development and the Department of Veterans Affairs to seek reimbursement for losses arising from foreclosures on government insured or guaranteed mortgage loans written by the company.
	www.taf.org /total2004.htm (963 words)

	City of Issaquah - False Alarms
		The Issaquah Police Department is responsible for the tracking and billing of false alarms.
		An alarm is considered a false alarm if it is activated by human error or if upon arrival the police find no evidence of an attempted unlawful entry.
		Three (3) false alarms from any such system in any calendar year shall be prima facie evidence of failure of the person having the right to possession or control to comply with this section.
	www.ci.issaquah.wa.us /page.asp?navid=284 (270 words)

	New False Alarm Software Web Site; Purvis Gray Technology Group, LLC a leading technology firm announces their new ...
		False Alarm Reduction Software is an accounting and management solution proven with 50 plus years of CPA (Purvis Gray and Company — www.purvisgray.com) experience with cities, counties, and other governmental agencies.
		Master Billing Accounts - The software allows the optional use of “master billing accounts” which can be used to bill and track multiple locations under one billing account such as a local business chain or apartment complex.
		Our False Alarm Billing System is a Microsoft 32-bit, Microsoft.NET Framework, and Microsoft SQL Server application, which gives you the flexibility of having your false alarm reduction solution available to existing windows desktop computers or a web browser.
	www.emediawire.com /releases/2004/6/emw131712.htm (808 words)

	Law Offices of Mark Kleiman
		The issue is whether the material submitted is actually false, and arguments about regulatory ambiguity go not to the question of truth or falsity, but merely to the question of whether or not the defendant had the requisite state of mind.
		The government relied upon a false statement in a cost report, without any reported evidence that the false statements had been coupled with overcharges, concealed costs, or any economic injury other than the hospital's false certification by the Center that it was eligible to receive Medicare money because it had honestly reported its organizational status.
		Kent filed a whistleblower action alleging false records were used to submit bills to the government, and also alleged that she was fired in retaliation for her testimony about this before a grand jury.
	www.falseclaimspecialist.com /library/texas_nela2.html (12059 words)

	northjersey.com - Montclair Times Community
		This was caused by false alarms, which require response from public safety personnel.
		As a result, municipal officials are considering the Montclair Police Department’s proposal to enforce alarm registration, track false alarms, and establish a billing service.
		As part of the proposed contract, the township would assign a part-time false-alarm coordinator who would spend several hours each month interacting with the monitoring company, but there would be no other services or facilities provided by Montclair as part of the proposed agreement.
	www.montclairtimes.com /page.php?page=11182 (704 words)

	Health Care Initiatives Under the False Claims Act That Impact Hospitals (Site not responding. Last check: 2007-10-09)
		Third, the bill makes it significantly harder to prove that claims were wrongfully submitted by changing the burden of proof for all health care claims from the usual civil ''preponderance of the evidence'' standard to the elevated ''clear and convincing evidence'' standard.
		Of course, which category a false billing falls in is a very case-specific kind of analysis, and whether a claim fits under the category of an honest, inadvertent mistake or the ostrich in the sand or fraudulent, knowing billing depends on each case and each fact.
		Since the False Claims Act was first enacted in 1863, it has been become the Department's primary civil enforcement tool to combat fraud and other false billing in a variety of areas, including defense procurement, food stamps, HUD programs, and health care.
	commdocs.house.gov /committees/judiciary/hju59924.000/hju59924_0.HTM (17542 words)

	USATODAY.com - Wal-Mart, Rite Aid settle false billing charges (Site not responding. Last check: 2007-10-09)
		The department said that from 1997 through 2001, Rite Aid billed three government programs for drugs that never were delivered to beneficiaries and later were returned to stock.
		Under the False Claims Act, private citizens who bring suits against companies can receive a portion of the recovery in a case joined by the government.
		She said Rite Aid discontinued the practice years ago when the company became aware of the government's concern, and the company now has new procedures in place, a new computer system, and only bills for the exact amount of medicine that is actually picked up by the patient.
	www.usatoday.com /money/industries/health/drugs/2004-06-25-pharmacy_x.htm (437 words)

	False Alarm Billing Schedule - Printer friendly (Site not responding. Last check: 2007-10-09)
		A) To reduce the occurrence of false alarms; the owner or lessee of an alarm system shall pay to the City the following sums for each occasion that the alarm system is activated and responded to by the police and/or fire division in any of the following cases:
		The request to appeal any false alarm fees must be accompanied by a written explanation for activation of the alarm.
		If the board determines that the alarm was erroneously deemed a "false alarm" or was activated because of an emergency or by circumstances in which the false alarm was not avoidable by the use of due care, the board may waive the fee.
	www.livoniapd.com /false_alarm_print.htm (433 words)

	False Billing Schemes Against Business (Site not responding. Last check: 2007-10-09)
		In a false billing scheme, a swindler sends you an authentic-looking professionally produced invoice for products or services you never ordered or received.
		Some false billers simply prepare or obtain lists of businesses and mail invoices to them, hoping poor accounting procedures will result in some not questioning the validity of the invoices.
		Verify all billing authorizations, and don't pay until all invoices are verified to receiving reports.
	www.usps.com /postalinspectors/falsbill.htm (367 words)

	Digital Design Group, Inc. - Portal Directory Illinois Municipal League
		Digital Design Group’s False Alarm Data Management System is a comprehensive false alarm billing and tracking system for enforcing false alarm ordinances and administering false alarm reduction programs.
		The false alarm reduction software maintains data on alarm permits, false alarm dispatches, and alarm companies; automates the permit renewal process; invoices false alarm dispatch fees; accounts for all revenues; generates financial reports; follows up on unpaid invoices; and produces false alarm statistics.
		The false alarm software can import data from police CAD systems to eliminate the need to reenter dispatch data.
	www.iml.org /cdps/cditem.cfm?nid=953 (250 words)

	AT&T accused of false billing (Site not responding. Last check: 2007-10-09)
		The attorney general's office expects more victims to come forward because most people don't bother to look at the details of their phone bill and the charges involved easily are overlooked, ranging from $3.95 to about $10.
		The billing problem is nationwide and gradually leaked into public view in the past week, state by state.
		For those three months I was getting billed by 2 different companies for the same long distance service, the company I had chosen and MCI which said i was not permitted to change providers.
	www.freerepublic.com /focus/f-news/1131175/posts (2147 words)

	Consumer protection agencies join forces to protect Australian business from billing scams
		Australia's consumer protection agencies are stepping up their combined assault on false billing practices.
		The ACCC had alleged that Domain Names Australia Pty Ltd had made false or misleading representations to businesses which held a registered internet domain name by sending them notices inviting them to register a new internet domain name which was substantially similar to the business’s existing domain name.
		Proceedings continue against IT and T AG which has allegedly been falsely billing businesses for unsolicited entries in an international facsimile directory.
	www.accc.gov.au /content/index.phtml/itemId/523682 (976 words)

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