Medicare Compliance & Reimbursement

Hiring these 2 types of auditors can help keep your inner workings secure. The latest whistleblower case raises more questions about whether healthcare providers are vulnerable to quitam lawsuits brought by a billing consultant -- and how they can head off that prospect at the get-go. The nitty gritty: A hospital consultant, Tony Kite, filed qui tam lawsuits that triggered the Department of Justice to bring fraud charges against two separate hospitals. The False Claims Act lawsuits alleged that the hospitals had jacked up their Medicare costs in order to inappropriately capture outlier payments. The DOJ announced a settlement in one case last November, and the other one in late February 2010 (www.justice.gov/opa/pr/2010/February/10-civ-197.html). Kite reportedly netted more than a million dollars plus interest (minus his attorney fees). The kicker: Mr. Kite had been involved in previous whistleblower cases and appears to be what some refer to as a "professional whistleblower," [...]