News & Analysis as of

False Billing

Three Recent Fraud Cases Involving Dermatologists Illustrate Primary Compliance Risks in Dermatology Practices

by Ruder Ware on

Three relatively recent cases involving dermatology billing practices illustrate some of the main compliance risks faced by dermatology practices...more

When is a Physician Liable for Stark Law Violations?

by Ruder Ware on

I frequently hear attorneys claim the Stark law applies equally to hospitals and physicians. This position is sometimes taken in the process of negotiating a transaction between a hospital and a physician or physician group....more

Percentage-Based Billing Contracts Violate Medicaid Regulations and May Constitute Improper Fee-Splitting

by Farrell Fritz, P.C. on

The Medicaid Fraud Control Unit (MCFU) of the New York State Office of the Attorney General has recently issued restitution demand letters to providers for allegedly entering into percentage-based contracts with their billing...more

New York Medical Society Warns Providers to Avoid Percentage-Based Billing

A series of recoupment letters from the New York State Medicaid Fraud Control Unit (MFCU) to healthcare providers who have management or billing company arrangements based on a percentage of collections has prompted the...more

Mintz Levin Health Care Qui Tam Update: Recently Unsealed Whistleblower Cases

Featured Unsealed Cases United States ex rel. Thomas v. Best Choice Home Health Care Agency, Inc., No. 2:13-cv-02209 (D. Kan.) - Complaint Filed: May 6, 2013 - Complaint Unsealed: October 24, 2016...more

False Claims Act Dangers on Display in Ruckh

by Bass, Berry & Sims PLC on

A recent jury verdict in an FCA lawsuit pending in the United States District Court for the Middle District of Florida resulted in a not-so-subtle reminder of just how high the stakes can be in such litigation....more

Fourth Circuit Declines to Review Issue of Statistical Sampling Use in FCA Case

by King & Spalding on

On February 14, 2017, the U.S. Court of Appeals for the Fourth Circuit issued a long-awaited opinion in the case U.S. ex rel. Michaels v. Agape Senior Community, Inc. et al. (case number 15-2145 and 15-2147). In this FCA...more

The Case of the Very Very Impossibly Long, Terrible, Horrible, No Good, Very Bad Day

by Ruder Ware on

How Fraud and Abuse Cases Arise in a Medical Practice - It is no secret many doctors work very long days. Some days are worse and some are better than others. As a compliance lawyer, my job is to attempt to prevent...more

This Month in Corruption: Contractors Fined for False Billing on Assembly Sq. T

by PretiFlaherty on

Two contractors involved in building the Assembly Square T station knowingly submitted inflated payment estimates for materials and will pay large fines and penalties to resolve the case, according to the Office of Attorney...more

Proof by Proxy in FCA Suits? District Court Says It Depends

by Morgan Lewis on

Admissibility of statistical sampling to prove liability in FCA suit is fact dependent. In a February 14, 2017 decision, the Fourth Circuit declined to rule on the question of whether statistical sampling can be used to...more

Fourth Circuit Takes a Pass on Statistical Sampling, Finds DOJ's Settlement Veto Authority Unreviewable

by Bass, Berry & Sims PLC on

After granting the relators’ petition for an interlocutory review of the district court’s rejection of the use of statistical sampling to establish FCA liability, the Fourth Circuit ultimately declined to reach that issue in...more

Health Care Fraud and Abuse in the Middle District of Florida in 2016 - a Year in Review

by Carlton Fields on

The United States Attorney’s Office (USAO) for the Middle District of Florida (USAO-MDFL) prosecuted several civil health care fraud matters in 2016 and issued related press releases. A review of the USAO-MDFL’s criminal and...more

Recent Settlements Demonstrate the Reach and Versatility of the FCA

by Bass, Berry & Sims PLC on

In recent years, civil enforcement efforts involving the FCA have grown significantly. Today, the FCA impacts a vast array of businesses, as it is commonly used to redress false claims for government funds involving...more

Ninth Circuit Substantially Reduces Punitive Award Against Walgreen

Things have been quiet in the world of punitive damages for the last few months, but two recent decisions substantially reducing punitive awards under the BMW/State Farm factors warrant mention. My colleague Miriam Nemetz...more

Billing Companies Beware – OIG Signals a Crackdown on Fraud and Abuse at All Levels

In an unprecedented administrative action, the U.S. Department of Health & Human Services Office of the Inspector General (“HHS-OIG”) penalized a medical billing company for preparing and submitting claims to Medicare for...more

Fourth Circuit Interprets Meaning of "Protected Activity" Under 2010 FCA Whistleblower Amendments

by Bass, Berry & Sims PLC on

The U.S. Court of Appeals for the Fourth Circuit recently affirmed dismissal of an FCA complaint for failure to state a claim under the FCA’s anti-retaliation provision, 31 U.S.C. § 3730(h). In U.S. ex rel. Carlson v. Dyncorp...more

Can a Relator Plead with Particularity without Alleging that a Patient’s Bill was Submitted to the Government?

by McGuireWoods LLP on

The Seventh Circuit says yes. Early this month, the Seventh Circuit reversed and remanded a district court’s holding that a qui tam Relator failed to properly plead a False Claims Act suit where the Complaint did not allege...more

Former Home Health Agency Owner Sentenced to 20 Years for $57MM Medicare Fraud

The US Department of Justice announced that Khaled Elbeblaswy, the former owner and manager three Miami-area home health agencies, was sentenced to 20 years in prison and ordered to pay $36.4 million in restitution for his...more

NYAG Announces Settlement with Synergy Fitness for Improper Billing

by Klein Moynihan Turco LLP on

This week, the New York State Attorney General (the “Attorney General”) announced that it had settled with nine Synergy Fitness (“Synergy”) health clubs over alleged deceptive and improper billing practices. Specifically,...more

Mintz Levin Health Care Qui Tam Update - Recently Unsealed Whistleblower Cases: August 2016

by Mintz Levin on

Since our last issue, we have identified 31 recently unsealed health care-related whistleblower cases. In this Qui Tam Update, we analyze the trends and take an in-depth look at a few noteworthy cases....more

NYAG Announces Deceptive Advertising Settlements

by Klein Moynihan Turco LLP on

Last week, the New York State Attorney General (the “Attorney General”) announced settlements with two separate companies relating to claims involving allegations of deceptive advertising and billing practices. The...more

Health Care Fraud Prosecutions: Strong Seas and High Winds Ahead for Individuals and Corporations

by Baker Ober Health Law on

During the past nine months, the U.S. Department of Justice (DOJ) has made several significant policy pronouncements that impact health care organizations and individual providers. These directives and initiatives reflect...more

Clinics Pay Heavy Price for Failing to Audit Claims

by Faegre Baker Daniels on

Health clinics may want to review their auditing obligations and practices in light of a June 23 ruling by the Eleventh Circuit. Allstate decided to look into the billing practices of a group of Florida health clinics. ...more

OIG Delivers Home Care a One – Two Punch: Release of Report and Alert on Home Health Fraud Highlights Increased OIG Scrutiny of...

On June 22, 2016, the Office of Inspector General (“OIG”) issued two communications that underscore its continued focus on fraud in home health care, along with the role of physicians as “gate keepers” in authorizing...more

Battle of the Somme Week – Part I: The Analogic FCPA Enforcement Action

by Thomas Fox on

I have not written much in honor of the centennial of the First World War (WWI). However this week I will to remedy this oversight by focusing on the Battle of the Somme, leading up to the first day of the long battle, which...more

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