8:41 AM, Oct 28, 2014 • By DANIEL HALPER
The federal government is taking New York City to court. "Manhattan U.S. Attorney Files Healthcare Fraud Lawsuit Against Computer Sciences Corp. And The City Of New York For Orchestrating A Multimillion-Dollar Medicaid Billing Fraud Scheme," reads a headline from the Justice Department's press release.
"Suit Alleges Computer Sciences Corp. and New York City Systematically Submitted Tens of Thousands of Claims to Medicaid Without Exhausting Private Insurance Coverage and Also Switched Diagnosis Codes in Tens of Thousands of Medicaid Claims to Get Those Claims Paid."
Preet Bharara, the United States Attorney for the Southern District of New York, announced today that the United States has filed a civil healthcare fraud lawsuit in Manhattan federal court against COMPUTER SCIENCES CORP. (“CSC”) and the CITY OF NEW YORK (the “CITY”). The Government’s Complaint seeks treble damages and civil penalties under the False Claims Act against CSC and the CITY for orchestrating billing fraud schemes that used computer programs to automatically alter billing data. Two of the schemes involved CSC and the CITY using computer programs to circumvent the requirement that Medicaid should be billed after private insurance coverage had been exhausted, and a third scheme involved the use of a defaulting program to systematically falsify diagnosis codes submitted to Medicaid. According to the Complaint, these fraud schemes caused the submission of tens of thousands of false claims to Medicaid and allowed the CITY, through CSC, improperly to obtain millions of dollars of Medicaid reimbursements.
Manhattan U.S. Attorney Preet Bharara said: “As alleged, CSC and the City created computer programs that systematically, and fraudulently, altered billing data in order to get paid by Medicaid as quickly as possible and as much as possible. Billing frauds like those alleged undermine the integrity of public healthcare programs like Medicaid. All public healthcare program participants, whether they are healthcare providers, localities like the City, or contractors like CSC, should understand that they must comply with the applicable billing rules.”
The following allegations are based on the Complaint filed today in Manhattan federal court:
In New York State, early intervention program (“EIP”) services are available to children under the age of three who demonstrated developmental delay or have been diagnosed with medical conditions likely to cause delay. For children in New York City receiving EIP services, the CITY was responsible for processing and paying claims submitted by service providers, then seeking coverage from private insurers or Medicaid or billing New York State for its 49% share of the costs not covered by private insurance or Medicaid.
To minimize its share of the costs of the EIP services, the CITY set annual targets for Medicaid payments and made it a priority to obtain Medicaid payments as soon as possible and for as much as possible. The CITY contracted with CSC to process service provider claims and then seek coverage from private insurers, Medicaid, or the State. To ensure that CSC would focus on obtaining Medicaid payments, the CITY offered CSC financial incentives for exceeding certain targets for Medicaid payments and imposed penalties when CSC failed to meet the CITY’s goals for Medicaid payments. To meet those targets, CSC and the CITY implemented billing fraud schemes using computer programs that automatically altered billing data.
Two of these schemes were designed to circumvent Medicaid’s secondary payor requirement, which required the CITY and CSC to exhaust private insurance coverage before billing Medicaid. In the first scheme, rather than obtaining correct private insurance policy IDs for children who had missing or incomplete policy IDs, CSC developed a program to identify missing insurance policy IDs and then applied a default policy number of 999-999-999, which CSC and the CITY knew would result in denials by private insurers. This scheme enabled CSC and the CITY to submit tens of thousands of false claims to Medicaid without exhausting private insurance coverage and to obtain millions of dollars from Medicaid improperly.
9:08 AM, Sep 22, 2014 • By SCOTT SMITH
With the announcement in Kabul of a power-sharing government between the two presidential candidates, Ashraf Ghani and Abdullah Abdullah, the Afghan election comes closer to a resolution. What is missing, however, is an actual result. The “national unity government” was one part of a deal brokered by U.S. Secretary of State John Kerry back in July, when preliminary official results gave Ghani a massive victory, and Abdullah threatened to pull out of the process, claiming massive fraud had taken place. After two months of an audit overseen by the UN, when every ballot box was re-examined—something unprecedented in electoral history—a final result was reached. The result was given last week in secret to the candidates, but not to the public.
'A billion dollar government contract involving hundreds of local workers'...8:12 AM, May 13, 2014 • By DANIEL HALPER
An eye-opening report from KMOV about an Obamacare contractor using taxpayer dollars to pay their employees to spend all day doing nothing:
"A billion dollar government contract involving hundreds of local workers at an Obamacare processing center ... But now employees on the inside are stepping forward, asking, Is this why we're broke? Some of them claim to spend most of their day doing nothing," reports a local St. Louis reporter.
7:06 AM, Apr 15, 2014 • By JERYL BIER
Four years after Obamacare became law, the Department of Health and Human Services (HHS) is notifying Medicare providers and suppliers of new fingerprint-based background checks. Eventually, all individuals who hold a five percent or greater stake in a Medicare supplier or provider that is categorized as "high risk" will be subject to the requirement.
9:30 AM, Jan 11, 2014 • By IRWIN M. STELZER
Here we go again. JPMorgan Chase will pay $2.6 billion in fines and compensation for its inattention to numerous red flags warning that its important customer, one Bernie Madoff, was running a $65 billion Ponzi scheme.
Dec 30, 2013, Vol. 19, No. 16 • By THE SCRAPBOOK
Truth to tell, The Scrapbook has gotten as good a laugh as anyone out of the saga of John C. Beale, the retired Environmental Protection Agency official—Princeton grad, onetime deputy assistant administrator in the Office of Air and Radiation, congressionally certified expert on global warming—who has been sentenced to 32 months in prison for stealing nearly a million dollars from the federal government.
3:21 PM, Nov 12, 2013 • By JERYL BIER
The Treasury Inspector General for Tax Administration (TIGTA) reported last week that in 2011, the IRS paid out $3.6 billion in fraudulent refunds on tax returns filed by identity thieves. Even that amount was an improvement over the previous year when the total fraud was $5.2 billion. However, on Tuesday, TIGTA released a new report that found that though the IRS is making some progress against fraud, it is not using all available tools to prevent erroneous refunds and improper tax credits.
Plus, the law's privacy problems haven't disappeared.2:42 PM, Sep 12, 2013 • By MICHAEL WARREN
As the October 1 implementation of parts of Obamacare nears, House Republicans continue to pass legislation aimed at highlighting the health care law's flaws and weaknesses. On Thursday, the House passed a bill to reform an Obamacare verification process that would better stop fraudulent claims to health insurance subsidies. Politico reports:
8:44 AM, Aug 29, 2013 • By JERYL BIER
The state of Alabama received bonus payments from Medicaid for 2009 and 2010 that were a stunning 13 times higher than the state was eligible for. So says the inspector general (IG) for Health and Human Services in a report released on Wednesday.
Food stamp trafficking a record $858M in 20117:58 AM, Aug 16, 2013 • By JERYL BIER
The U.S. Department of Agriculture (USDA) released a report on Thursday regarding illegal trafficking in the Supplemental Nutrition Assistance Program (SNAP), more commonly known as food stamps. The report showed that the rate of trafficking rose from 1 percent of total benefits in the last study period of 2006-2008 to 1.3 percent in the current study period of 2009-2011, an increase of 30 percent. The report noted the trafficking rate remains well below a rate of almost 4 percent that existed for much of the 1990s. The rate plunged to 1 percent by the 2002-2005 study period and remained there until the current report:
7:02 AM, Jul 16, 2013 • By JERYL BIER
Despite an admission by the Department of Transportation (DOT) that the Federal-aid Highway Programs under the American Recovery and Reinvestment Act (ARRA) are "susceptible to significant improper payments," the DOT Inspector General (IG) has terminated an audit initiated in April "due to other higher priority work demands."
1:50 PM, Jul 8, 2013 • By JAMES C. CAPRETTA
On Friday, the Obama administration dropped another health care implementation bombshell.