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CMS Aims to Grease the Reporting Wheels for Medicare Fraud and Abuse

Proposed rule would substantially increase rewards for fraud tips and enhance billing revocation authority. On April 29, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule (Proposed Rule) that...more

20 Million Reasons Why Class Action Defendants Need to Read Their Insurance Policies Closely

As previously noted in a recent blog post, defendants should immediately evaluate their insurance coverage upon receipt of a class action complaint. But as one defendant recently discovered the hard way, that evaluation must...more

Blue Cross Must Pay $4M For Dropping Patient-Advocate Doc

A doctor who claimed health insurer Anthem Blue Cross retaliated against him for being a strong patient advocate, has won a $3.8 million verdict against the insurer....more

SCOTUS Declines Review in Case Allowing Health Care Provider to Pursue State Law Misrepresentation Claims Against ERISA Health...

The United States Supreme Court recently denied certiorari in a Fifth Circuit case, United Healthcare Insurance Co. v. Access Mediquip LLC, that allowed a health care provider to pursue state law misrepresentation claims...more

The ERISA Litigation Newsletter - September 2012

In This Issue: - Editor's Overview - ERISA Preemption in Provider Misrepresentation Claims: An Overview of the Jurisprudence Leading Up to the Fifth Circuit's En Banc Review of Access Mediquip and What Lies...more

TPA is a Fiduciary Under ERISA

A recent Sixth Circuit Court of Appeals decision considered whether a third party administrator of a self-funded medical plan was a fiduciary under ERISA. Under ERISA, fiduciaries owe strict duties of loyalty and prudence to...more

DOJ Takes New Tack on Hospital Recoupments: Implantable Cardiac Defibrillators

The U.S. Department of Justice has sent emails to hospitals across the country regarding implantable cardioverter defibrillators, asking the hospitals to self-audit and estimate possible penalties under the False Claims Act....more

Medicare Strike Force Team Charges 107 Individuals for Approximately $452 Million in False Billing

On May 2, DOJ and HHS announced charges against 107 individuals, including doctors, nurses and other licensed medical professionals, across the country for allegedly participating in Medicare fraud schemes totaling $452...more

Medicare Fraud Strike Force Bust Involves Highest Amount of False Billings in a Single Takedown

2012 is already a record-breaking year in health care fraud enforcement. This week Attorney General Eric Holder and Secretary of the Department of Health and Human Services (HHS) Kathleen Sebelius announced the biggest...more

Open Letter from Senate Finance Committee Seeks Fraud-Fighting Input

Yesterday the Senate Finance Committee posted an open letter on its website to the health care sector soliciting industry stakeholder insights on ways to combat fraud, waste, and abuse in the Medicare and Medicaid programs. ...more

Senate Committee Holds Hearing on Health Care Fraud Enforcement

A hearing titled Anatomy of a Fraud Bust: From Investigation to Conviction held by the Senate Committee on Finance (Committee) on April 24th allowed federal health care agencies to both tout their fraud-fighting successes,...more

Tenet Will Pay $42.75 Million to Settle Inpatient Rehabilitation Admissions Investigation

On April 10, 2012, the DOJ announced that Tenet Healthcare Corporation will pay $42.75 million to settle civil allegations that Tenet violated the False Claims Act by improperly billing CMS for services provided at inpatient...more

Specificity Required: Pleading Requirements Not Met for Medical Providers Pursuing ERISA Benefits Via Their Patient's Assignment

Medical providers must specifically allege the medical plans, the terms breached, and the assignment when pursuing benefits by assignment from their patients under Employee Retirement Income Security Act of 1974 (ERISA). In...more

Denver Health Medical Center Settles FCA Short Stay Suit for $6.3 Million

Denver Health and Hospital Authority, d/b/a Denver Health Medical Center (DHMC), has agreed to pay $6.3 million to settle a False Claims Act suit alleging that, between 2006 and 2009, it “submitted false claims to Medicare...more

DOJ Escalates Its War on Health Care Fraud: GlaxoSmithKline Agrees to Pay Record-setting $3 Billion to Settle U.S. Investigations

British pharmaceutical company GlaxoSmithKline (GSK) announced on November 3, 2011, that it had reached an agreement in principle with the United States government to resolve multiple federal investigations regarding the...more

Star Discount Pharmacy v. MedImpact

Complaint

We represent several independent pharmacies in Alabama who have been damaged by the defendants' efforts to close and/or limit access to the pharmacy network available for school teachers in our state....more

Health Law Alert - April 2011

Insurance companies have been using computer technology to target providers with greater effect, but not always with the correct result. If you are a specialist who utilizes a set of medical codes more than any other codes,...more

Revision of Earnings Due to Overbilling Supports Fraud Claims

Allegations that a medical device manufacturer knowingly overbilled insurance companies and reported these unrecoverable accounts as income were sufficient to support security fraud claims. According to plaintiffs, Zynex...more

Common Fatal Mistakes in Doctor's Disabilty Claims - Asset Protection

One form of insurance protects one of your most valuable assets, your income, in the form of disability insurance. One of the legal professionals on my short list of regular resources is Attorney Edward Comitz, the guy I call...more