Two recent Department of Justice settlements with health care providers shine a new spotlight on a long-standing risk for health care fraud and abuse.
Background
Thirty years ago, coding and billing for physician services was a headline topic in Medicare and Medicaid fraud. Numerous academic medical centers such as the University of Pennsylvania (Penn) were forced to reimburse the federal government for claims that systematically misrepresented the physician services actually provided. In 1995, Penn agreed to pay $10 million as reimbursement to Medicare for paid services and an additional $20 million as a penalty under provisions of the False Claims Act (FCA) that allow for tripling of damages.
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