Article or Case Law Search

Topics: Medicaid, Health insurance Pages: 5 (813 words) Published: August 16, 2015


Article/Case Law Search
Roxannalee Berndsen
July 9, 2015
HCS/430
Christie Artuso

The article that was read and researched was titled,” Hospitals to pay $2.3M for alleged Medicaid overbilling, drug profits.” After reading the article, it was determined that there were two Westchester County hospitals that had been told they had been overbilling the Medicaid program and the total was more than $70 million. This was done by improperly approving home health care for patients who received Medicaid. When the Attorney General’s Medicaid Fraud Control Unit investigated, it was found that the two hospitals were both proven to be billing Medicaid more for the cost of services and had a substantial, seven figure profit. Even after this information was found, neither of the hospitals came forward and admitted it, but they did not ever deny the accusations, either. Instead of owning up to it, the hospitals paid double the fine that was being charged.

The problem, now, is that some health care leaders are concerned that the extra billing mistake of the Medicaid could possibly be taken as fraud. The argument will be whether it truly is fraud or not. In the article, it was stated that, “A label of fraud is really not accurate and can discredit the institution in the community," Northern Metropolitan Hospital Association President and CEO Kevin Dahill told the Journal News. "Hospitals participate in these audits and agree to the findings. If they make mistakes, they correct them. That's not fraud."(Caramenico, 2012). If this was truly just a billing mistake, then of course it should not be considered as fraud. However, if it was just a small amount of money and only happened here and there, then yes, it could be looked over and just considered as a mistake. When the amount is over millions of dollars and there is more than one hospital or practice, then obviously it is happening on a regular basis and should be taken as fraud. It could be that some employers were not trained correctly or are putting in the wrong codes for billing, but enough is enough. If it gets corrected and does not happen again, then everything should be fine, but if it keeps reoccurring then there is more to the story than just a simple mistake.

It most likely that these accusations of the fraud of overbilling the Medicaid program have been brought up more than once. Not only should the hospitals have to pay this money back, including interest if there is any, but the people who are continually responsible should be reprimanded, as well. As previously stated, if it was a mistake that is fine, correct it, but if it happens over and over by the same staffing, then something needs to be done. The fraud department handled this in the correct way. There was an investigation put in place and even if the hospitals never admitted to anything, they paid more than what was needed for the fines, which in turn could possibly prove guilt. It was most likely just to keep the hospitals out of the media.

This article does relate to the functions of laws. When the hospitals agreed to paying double the amount of fines, the fraud control unit should be able to enforce this issue. Also, the article related to the nature of the law because there was evidence brought forth that there was overbilling to Medicaid and showed that the hospitals were gaining such a huge profit. When businesses, organization, or places like hospitals get involved with legal issues, it makes not only the company look bad, but as do the employees. In being hopeful, the committees and administration of the hospitals would like to keep this as hush as possible. The biggest mistake would be that the public gets ahold of this information and runs with it and that would only being more attention to these hospitals in a negative way.

The main goal of companies are to keep a good reputation. Whether that be with employees, committees, and the public eye,...

References: Caramenico, A. (2012). Fierce Healthcare. Retrieved from http://www.fiercehealthcare.com/story/hospitals-pay-23m-alleged-medicaid-overbilling-drug-profits/2012-04-20
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