Thursday, August 28, 2008

Illegals draining Social Services. A lie or a Lie?

Another case were I exposed the unethical and Illegal behavior from Companies. They thought they were going to get away with it and so they refused to change their illegal practices and kept alienating persons of conscience. Every hospital will be full of stories of heroism and mistakes blaming the other. And This is not about accidents, or complicated book keeping or reporting procedures. It is about white collar crime; crime at such a level that it has been difficult for low paid Federal employees to get their minds around the tens of millions of dollars involved and too complex for the news media to grasp. Finally, it is starting to unravel. Bring on the indictments not the Undocumented Immigrants.

CoxHealth has agreed to pay more than $60 million to settled a False Claims Act lawsuit in which the company was charged with overbilling Medicare. CoxHealth actually stole more money that they are being required to return to the U.S. Government because as federal agents began calculating the damages, it soon became clear Cox could not pay without going under

CoxHealth's $60 million settlement with the U.S. Justice Department will cost the health system an extra $3.07 million when the bill is paid in full with interest in five years.

That's according to a government document filed with the settlement agreement Tuesday.
The money will compensate the Medicare trust fund for a portion of the payments that Cox improperly claimed and received, the government said. The trust fund is the pool of taxpayer money from which the Medicare program pays hospitals, providers and beneficiaries.

Cox will pay $35 million immediately, then $5 million each year for five years with 4 percent interest on the deferred amounts. Cox officials say they already have the money in various reserve accounts.

The $60 million settlement "is considerably less than the alleged improper Medicare payments to Cox," U.S. Attorney John Wood said this week.

Federal officials agreed on that amount because that's what Cox could afford to pay without damaging its ability to provide medical care to the community, he said.

Officials won't divulge the estimated total amount of those alleged improper payments
But Assistant U.S. Attorney Joel May said it became clear as federal agents began calculating alleged claims, "There's no way Cox would ever be able to pay without going under

She added, "That's when we switched gears to an 'ability-to-pay' posture."

The goal was to find a balance, May said.

"It is a priority for us to protect taxpayer dollars. Eventually it comes to practicality. You can't run a hospital out of business. That does not serve your community at all," she said. "It's the important art of weighing and balancing the need to protect the Medicare Trust Fund and the community's need for health care."

The U.S. Department of Justice alleges that Cox billed and received an undisclosed amount of Medicare payments it should not have gotten, and alleges it violated federal laws by providing kickbacks to physicians of the for-profit Ferrell-Duncan Clinic Inc.

The government is still negotiating a settlement with the physician-owned clinic, the government confirmed. Likewise, May said, its criminal investigation into alleged Medicare fraud at Cox continues.

How does a $60 million settlement compare with others?

According to Patrick Burns, spokesman with Washington, D.C.-based Taxpayers Against Fraud, the Cox settlement will be among the 20 largest settlements this year.

Burns' group is a nonprofit, public interest organization that aims to combat fraud against the federal government through the promotion and use of the Federal False Claims Act.

The settlement range is a low of about $10,000 up to one large system's cumulative $1.7 billion, he said. However, $900 million is the largest for a single defendant, he said.

The U.S. Department of Justice handles about 100 cases of the 300 to 400 false claims cases filed every year, Burns said. About 80 percent of those 100 are alleged health care fraud, he said.

Half of those 100 cases, he added, will be settled for less than $2 million

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