False Billing

News & Analysis as of

Brace Yourself: The RACs Are Back

Under the controversial program private contractors audit hospitals and other Medicare providers for fraudulent and erroneous Medicare billing. Why is it controversial? Because the auditors are paid a percentage of...more

The Halifax $85 Million Lesson: Compensation Arrangements Between Hospitals and Physicians Must Be Reviewed

The Department of Justice (“DOJ”) announced another multi-million dollar settlement of alleged False Claims Act violations on March 11, 2014. Specifically, Halifax Hospital Medical Center and Halifax Staffing, Inc. agreed to...more

Whistleblower’s one-two punch: Confidential informant/employee spurs criminal investigation, then successfully sues individual...

Schuylkill Products case highlights how a whistleblower can put an employer on track to face both criminal and civil proceedings under the False Claims Act....more

Second Circuit Dismisses $50 Million FCA Suit

Last week, the United States Court of Appeals for the Second Circuit affirmed the dismissal of a False Claims Act (“FCA”) whistleblower suit seeking $50 million in damages from Huron Consulting Group Inc. (“Huron”) for...more

Recent FCA Decision Has Important Implications for Contractor Disclosures to the Government

A recent decision from the U.S. District Court for the Eastern District of Virginia has important implications for government contractors that make mandatory disclosures of improper conduct to the U.S. Government. In U.S. ex...more

Eastern District of Virginia Finds False Claim Allegations Too Speculative

A Virginia federal judge recently dismissed a retaliation complaint under the False Claims Act because the plaintiff’s allegations of a false claim against the government were too speculative. In Carlson v. DynCorp...more

Long Island Radiology Group Settles FCA Allegations That It Billed Medicaid And Medicare For Unnecessary Tests For $15.5M

A company operating diagnostic testing facilities in New York has agreed to pay $13.65 million to the federal government and $1.85 million to New York and New Jersey for a total of $15.5 million in penalties to settle claims...more

Medical Device Manufacturer Settles False Billing Allegations for up to $5.25 Million

On February 19, 2014, the DOJ announced it reached a settlement with EndoGastric Solutions, Inc. (EndoGastric) to resolve a pending False Claims Act (FCA) suit. EndoGastric manufactures and sells a medical device called...more

Everyone Gets To See The Evidence: The California Court Of Appeal Rejects an Attorneys’ Fee Award Based On The Trial Court’s In...

In Concepcion v. Amscan Holdings, Inc. et al., — Cal.Rptr.3d —-, 2014 WL 595822 (Cal.App. 2 Dist. Feb. 18, 2014) the California Court of Appeal rejected class counsel’s fee award where class counsel’s billing records were...more

2014 OIG Work Plan: Questionable Billing Patterns for Part B Services During Nursing Home Stays

The 2014 OIG Work Plan includes the following: Billing and Payments. We will identify questionable billing patterns associated with nursing homes and Medicare providers for Part B services provided to nursing home...more

Lost Or Stolen: Liability For Unauthorized Credit Card Charges

On a brisk January day, Mary A. Richman opened her mailbox and was confronted with the sobering sight of thick envelopes from Visa, American Express and MasterCard each containing a month’s worth of extravagant Christmas...more

Case Study of a CFPB Enforcement Action: In re JPMorgan Chase Bank, N.A.; and Chase Bank USA, N.A.

The Consumer Financial Protection Bureau (CFPB) brought an enforcement action against JPMorgan Chase Bank, N.A. and Chase Bank USA, N.A. (collectively, the Bank), pursuant to 12 U.S.C. §§ 5563 and 5565 with regard to their...more

Mintz Levin Health Care Qui Tam Update - Recent Developments & Unsealed Cases

Trends and Analysis: ..We have identified 21 health care–related qui tam cases unsealed since last month’s Qui Tam Update. Of those, two were filed in 2013, 15 were filed in 2011 or 2012, and four were filed in 2010 or...more

Infosys Settles Visa Claim for $34 Million

Indian tech giant Infosys has reached a $34 million civil settlement with the US government for allegedly misusing the US visa system. The company was accused of obtaining business visitor, B-1, visas instead of H-1B work...more

DLA bill padding scandal; “I’m shocked”

This week we learned that a client of DLA Piper had counter-sued the firm because it [allegedly] overbilled him. Much has been written about the emails from one DLA lawyer to another with the salacious quotes: “churn that...more

CMS Focuses on Fraud Associated with Increased Use of Electronic Health Records

Acting CMS Administrator, Marilyn Tavenner, recently reaffirmed the agency’s concern that the increased use of electronic health records (“EHRs”) has contributed to increases in fraudulent billing practices by providers. At a...more

FTC Halts Alleged Illegal Consumer Account Billing Operation

On February 20, the FTC announced that it obtained a preliminary injunction in the U.S. District Court for the District of Nevada against a firm and affiliated entities alleged to have debited consumers’ bank accounts and...more

To Waive or Not to Waive, That is the Question

A burgeoning problem is developing for out of-network healthcare providers that systemically fail to collect deductibles and coinsurance from patients. Insurance companies often seek to deny insurance coverage to subscribers...more

OIG Reports on Questionable Billing for Mental Health Services

As its title makes clear, the August 2012 report “Questionable Billing by Community Mental Health Centers” (the Report) by the U.S. Department of Health and Human Services Office of Inspector General (OIG) demonstrates its...more

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