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In Protection Strategies, Inc. v. Starr Indemnity & Liability Co., the U.S. District Court for the Eastern District of Virginia allowed an insurer to recoup more than $670,000 in costs paid for the insured first to respond to...more
On April 16, 2013, the United States Department of Justice (DOJ) and U.S. Attorney’s Office in the Northern District of Illinois announced the arrest in Chicago of the owner and senior executive of Sacred Heart Hospital...more
Last year was another busy year in health care fraud enforcement. In 2012, the Office of Inspector General for the Department of Health and Human Services (HHS-OIG) reported total expected recoveries of $6.9 billion from all...more
A 2007 audit initiated by a Medicare Program Safeguard Contractor (PSC) discovered that a North Carolina provider had a high incidence of inpatient billings for patients who did not stay in the hospital overnight. The PSC's...more
The HHS Office of Inspector General has targeted hospitals for fraud enforcement. It is one of the OIG’s most important initiatives because of the impact it could have on reducing health care costs....more
To paraphrase a famous quote, "Those who do not learn from history are doomed to repeat it," and providers who ignore the significance of the federal government's healthcare fraud enforcements efforts in 2012 do so at their...more
A Federal district court judge issued a February 8, 2013 order granting a delayed prosecution against Raleigh, NC-based WakeMed Health and Hospitals for allegedly submitting false inpatient bills to Medicare. The...more
When it comes to healthcare fraud enforcement, the government knows how to target its resources. It is estimated that at least 25 percent of all claims paid by Medicare are improper. The government understands the...more
The Justice Department and the Department of Health and Human Services have made healthcare fraud a number one priority – it is another example of the synergy of politics and enforcement. Congress spends more money on...more
Hospital administrators should be nervous. The Justice Department and HHS are out to pressure service providers, including hospitals and doctors, to reduce costs. In Washington, hospitals and doctors are perceived to be a...more
Sometimes the deck is stacked against you. No matter what you do and how hard you try, you will lose.
In the healthcare area, hospitals, doctors and other service providers have to feel the frustration when it comes...more
On July 26, 2012, the U.S. Department of Health and Human Services (HHS) and the U.S. Attorney General’s Office announced that the federal government is creating a partnership with private payers and other state and private...more
This second part in our ongoing series reviewing health care fraud enforcement activities in 2011,i/ and monitoring enforcement in 2012, expands upon our prior discussion in part one (Part One Report) of the federal False...more
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