Fraud and Abuse

Fraud and Abuse United States v. Greber -- 3rd Circuit, 1985 Facts: Dr. Greber's company, Cardio-Med, supplied Holter monitors, a device worn by patients that records heartbeats for later interpretation. Investigations showed that Cardio-Med billed Medicare and gave a portion of each payment to the prescribing physician, under the heading, "interpretation fees," even when Dr. Greber actually did the interpretation of the data. It was found that the fixed percentage paid to the referring physicians was more than Medicare allowed for such services.

Further, Medicare requires that the device be used eight hours or more to qualify for payment. Cardio-Med and Dr. Greber reported longer operation times than the patients actually used their monitors. In 1977, Congress changed the fraud statute of Medicare to clarify such problems as "kickbacks." In the revised statute, kickbacks were defined as any remuneration that might in any way be perceived as encouraging one company to do business with only a certain company. Procedural History: United States Attorneys brought a number of fraud charges against Dr. Greber. Issues: 1.

Did Dr. Greber make claims for services or equipment that weren't needed or used at all? 2. Did Dr. Greber pay money from Medicare payments back to doctors who used his equipment? 3. Did Dr. Greber mis-report the amount of time his equipment was used? 4. Did Dr. Greber make payments to other physicians for services he provided? 5. Did Dr.

Greber use the United States Postal Service to bill for equipment and services that were never needed or used at all? Holding: Yes -- Fraud is in part defined as deliberately mis-representing a situation for gain. Yes -- he gave money from his payments to doctors who used his equipment. Yes -- he reported the required number of hours or more, regardless of how long the equipment was or was not used. Yes -- there is no legal reason to pay someone else for services you provided. Yes -- Dr.

Greber sent his billings through the mail. Rationale: Fraud is, in part defined as mis-representing a situation for personal gain. If Dr. Gerber tendered claims to Medicare for equipment.