Nursing Facilities / Fraud Alerts / Special Fraud Alert - August 1995 / False or Fraudulent Claims

Why This Topic Matters

It helps readers understand the kinds of nursing-facility supply and referral arrangements that may trigger fraud exposure under federal health care programs and related enforcement authorities.

Article Sections

1. False or Fraudulent Claims

   Overview of the fraud alert and the government’s focus on false or fraudulent claims involving nursing facilities and medical supplies.

2. Claims for medical supplies and equipment that are not medically necessary

   Discusses supplier billing patterns involving supplies associated with facility care and allegations of improper Medicare Part B reimbursement.

3. Claims for items that are not provided as claimed or double billed

   Addresses billing concerns involving delivered items, duplicate payment issues, and overlapping claims submitted for nursing-facility supplies.

4. Paying or receiving kickbacks in exchange for Medicare or Medicaid referrals

   Summarizes anti-kickback concerns related to supplier-facility arrangements and referral-based remuneration in the nursing-facility setting.

5. Other examples of fraudulent practices

   Lists additional complaint-based examples of supplier and facility conduct described by OIG in the fraud alert.