Lawyers are aware of the increasing sensitivity—and hostility—of clients to block-billing: lumping more than one activity into a single time entry. A new Fifth Circuit decision shows that courts can be equally sensitive—and...more
On April 19 the U.S. Supreme Court heard oral argument in Universal Health Services v. U.S. ex rel. Escobar. That’s the case in which the First Circuit upheld a whistleblower suit brought against a mental health clinic that...more
They do things big in Texas. The latest example is the punishments being handed out for a Medicare fraud scheme at Riverside General Hospital in Houston.
Let’s start with the fraud scheme. It was Texas-size, too,...more
Today’s riddle: Why would a federal court approve a medical device manufacturer’s practice of persuading physicians to exaggerate the period of time Medicare patients need their devices? The answer is so simple that you’ll be...more
Today’s riddle: why would the government take the defendant’s side against the whistleblower in a False Claims Act qui tam case? Why would the government challenge the whistleblower’s claim that two defendants violated the...more
Roxanne Perkins was employed as a clinical supervisor of prior authorizations therapy at Wellcare Health Plans. When she returned from a leave of absence, she learned that Wellcare had instituted a new practice of approving...more
Vicki Sheldon is the hands-down favorite to claim this month’s Most Imaginative Whistleblower Claim award. Vicki’s at-the-time husband Duane was employed at Kettering Health Network (KHN). Duane had an affair with another KHN...more
You have to feel sorry for whistleblower Darilyn Johnson. The former billing clerk thought she had a sure-fire, double-barrel False Claims Act (FCA) case against the medical clinic that fired her.
Barrel one was her...more
The Sixth Circuit brought a refreshing sense of reality to the government’s sometimes unreal calculation of damages in False Claims Act (FCA) cases. In this case the government had sought, and won at the trial level, an award...more
For years health care compliance officers have worried about personal liability for the misdeeds of the companies they serve. And why not? Health care is the most heavily regulated of all major industries, and the compliance...more
On February 11, 2016, the Centers for Medicare & Medicaid Services (CMS) released the much anticipated final rule on the so-called “60-day rule.” The long road to the final rule began when the Affordable Care Act (ACA)...more
Pity Dr. Christina Clardy. In 2011 she was convicted of health care fraud, sentenced to 135 months in prison, and ordered to pay $16 million in restitution. Then in 2014 the government added Christina as a defendant in its...more
The outcome of a physician whistleblower’s retaliation claim against his former medical group turns on the question whether whistleblowing was a reason or the reason he was fired. If it was a reason, he loses. If it was the...more
Jennifer Gierer says she was fired because she expressed concerns about her employer’s submission of false durable medical equipment claims to Medicare. So she sued her employer and her boss, alleging (a) retaliation under...more
Jeffrey Jacobs alleges that Idaho’s Pocatello Hospital violated the False Claims Act because of physician recruitment contracts that were overly generous to his practice group. Jeff should know because he was recruited under...more
10/7/2015
/ Anti-Kickback Statute ,
False Claims Act (FCA) ,
Hospitals ,
Medicaid ,
Medicare ,
Physicians ,
Recruitment Incentives ,
Recruitment Policies ,
Reimbursements ,
Stark Law ,
Whistleblowers
Okay, there’s not really a Most-Illegal-Physician-Compensation Prize. But if there were, Florida’s North Broward Hospital District would have won in a walk. That’s why the district has agreed to pay the government $69.5...more
During his days as a data encounter manager at SCAN, Jim suspected the company had been double-billing Medicare and Medicaid for years. He expressed his concerns within SCAN. When he refused a job reassignment, he was fired....more
Who knew? When you park for free at your doctor’s office, you may be a pawn in a scheme to violate the Anti-Kickback Statute, the Stark Law, and the False Claims Act. It’s enough to make you sick....more
Finding that Community Hospital Systems had been “too clever by half” in negotiating a global settlement agreement for seven whistleblower suits, a federal judge ordered the chain to pay the attorneys’ fees of all the...more
New York’s Mt. Sinai Hospitals can’t seem to catch a break in its long-running battle with whistleblower Bob Kane. First, the government joined the case and wanted not just the $1,000,000 in Medicaid overpayments, but an...more
Alisia and David blew the whistle on their former employer, Nurses’ Registry & Home Health, for sending gift baskets and ticket events to doctors who referred patients to the home health operation. Their qui tam suit alleged...more
7/22/2015
/ Anti-Kickback Statute ,
Client Referrals ,
False Claims Act (FCA) ,
Gifts ,
Home Health Care ,
Nurses ,
Physician Compensation Arrangements ,
Physicians ,
Qui Tam ,
Stark Law ,
Summary Judgment ,
Whistleblowers
The False Claims Act makes it illegal to obtain government money through false claims. Under the Act a private party, known as a relator, may bring a civil suit on the government’s behalf against an entity that has allegedly...more
The bill known as the “21st Century Cures,” H.R.6, would extend Civil Monetary Penalties (CMPs) to cover false claims and false statements relating to grants, contracts, and other agreements funded by the Department of Health...more
7/8/2015
/ 21st Century Cures Initiative ,
Civil Monetary Penalty ,
Clinical Trials ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
Federal Funding ,
Health Care Providers ,
Healthcare ,
Medicaid ,
Medicare ,
Pending Legislation ,
TRICARE
On May 26, 2015, the United States Supreme Court issued a decision favoring whistleblowers in False Claims Act cases, basing its decision in part on the status of the trial of Socrates.
...more
Yesterday’s U.S. Supreme Court decision is good news and bad news for both whistleblowers and government contractors, including health care providers–a win for whistleblowers on one important issue, for contractors on...more