William Nash filed a whistleblower case against his former employer but wanted to remain anonymous so that his new employer wouldn’t know that he is—you guessed it–a whistleblower.
William’s qui tam action alleged Medicaid...more
There are two major, interrelated reasons why government contractors, including Medicare providers, are so afraid of the False Claims Act (FCA). One is the draconian nature of the liability: treble damages plus up to $21,916...more
If you’re a surgical device distributor and you want to reward a surgeon for using your products on Medicare and Medicaid patients, you may want to choose a reward that’s less conspicuous than a yacht. That’s one lesson in...more
At first glance, it looks nonsensical. How could it be bad news for False Claims Act whistleblowers that the defendant pleaded guilty to violating that statute—to committing the very Medicare fraud the whistleblowers alleged?...more
A physician immigrated to the United States in 1991 and established a medical practice called Compassionate Doctors. By 2013 the practice and its related health care entities boasted some 44 employees and contractors,...more
If you think that ignorance of the law is no excuse, take a look at the Eleventh Circuit’s opinion in US ex rel. Phalp v. Lincare Holdings. It leaves no doubt that in a False Claims Act case, ignorance can be a solid defense....more
Intent is a necessary element of a False Claims Act (FCA) violation. If a defendant reasonably relied on advice of counsel in performing the actions at issue, the intent element is absent. That’s the upside of the...more
The recent decision in Dignity v. Burwell is interesting for three reasons. For one thing, it provides a reminder of the unfortunate fact that the acts (or inaction) of one party can adversely affect the fate of others—as...more
When Medicare beneficiaries are taken to the ER after an auto accident, they’re likely to have their Medicare cards with them, but not their auto policies. This creates a problem for Medicare because Medicare is supposed to...more
Generally speaking, patients really dislike balance billing. Sometimes called “surprise billing,” “balance billing” refers to billing a patient for the difference between the health care provider’s charge and the amount a...more
Charged with 33 counts of Medicare fraud netting some $45 million in false claims, Richard Tinimbang invoked a novel defense: “My mom made me do it!”
That, according to Law360, is the gist of the opening statement of...more
For years the hospital industry has been in an uproar over the mountainous backlog of Medicare claim appeals. Current estimates are that a whopping 650,000 claims are at the Administrative Law Judge level awaiting...more
Bill Clinton was President when Congress enacted a law requiring CMS to come up with qualifications for those who make or supply artificial limbs to Medicare patients. It was January 11, 2017, when CMS finally unveiled the...more
Competition for the 2016 Nerve-of-a-Burglar Award was fierce, with health care providers constantly coming up with new and different ways to scam Medicare and Medicaid. Nevertheless, we have a clear winner: the Michigan...more
A new Fifth Circuit opinion explains the difference between offering a benefit in order to induce a Medicare referral and offering it in the expectation of a referral. The difference is important because the former is a...more
You can tell by its name that you won’t like the Medicare “self-disallowance” rule. The federal district court for D.C. didn’t like it, either, and gave a group of Banner Health hospitals summary judgment that the rule was...more
An Eighth Circuit decision provides a reminder that the False Claims Act doesn’t forbid submitting false claims: it forbids knowingly submitting false claims. That made all the difference in an appeal of summary judgment in...more
I.A. Khair of New Jersey ran an ambulance company called K&S Invalid Coach. Presumably, “Invalid” was pronounced IN-va-lid, with the emphasis on the first syllable. Maybe it should have been pronounced in-VAL-id, with the...more
On July 7 CMS issued a proposed rule reaffirming its position that the Stark Law prohibits “per-click” rent payments when the lessor is the one referring the patients to the lessee for the “click,” e.g., the test or...more
Can it be a crime to provide free medical care? That’s the question presented by a post-conviction motion by the so-called King of Nursing Homes, Dr. V. Kuchipudi.
Dr. K was convicted on nine counts of violating the...more
Here’s a riddle: The whistleblower is a former employee of the defendant, with inside knowledge of the operations at the heart of his qui tam suit. How can that inside knowledge be a handicap in pressing his claim? A June...more
On June 20, 2016, The Kaiser Family Foundation issued the first ever broad-based study of Medicare Advantage hospital networks. The study — "Medicare Advantage Hospital Networks: How Much Do They Vary?"— analyzed 409 plans in...more
Michael Sorenson is an optometrist formerly employed by Outreach Diagnostic Clinic. After he quit, he filed a False Claims action against the eye clinic and the two doctors who owned it. He alleged that the clinic routinely...more
The Balanced Budget Bill Act of 2015 has a site-neutral billing provision relating to off-campus hospital outpatient departments (HOPDs). Those are facilities away from the hospital campus but certified as part of the...more
On May 2 a New Orleans federal jury found that Psalms 23 DME, LLC—its Biblical name notwithstanding–was part of a fraud scheme that illegally billed Medicare $3.2 million.
In 2013 the government indicted Psalms 23 owner...more