Three affiliated home health companies in Tennessee agreed to pay $1.8 million to settle False Claims Act (FCA) liability. That’s a lot of money, but it’s only about four percent of the $42 million in potential liability...more
If you’re a surgical device distributor and you want to reward a surgeon for using your products on Medicare and Medicaid patients, you may want to choose a reward that’s less conspicuous than a yacht. That’s one lesson in...more
A physician immigrated to the United States in 1991 and established a medical practice called Compassionate Doctors. By 2013 the practice and its related health care entities boasted some 44 employees and contractors,...more
Maria Paz Garza was the King Midas of incontinence supplies: she turned diapers into dollars—over two and a half million of them, according to the government’s indictment.
She did it through a scheme that charged Texas...more
Competition for the 2016 Nerve-of-a-Burglar Award was fierce, with health care providers constantly coming up with new and different ways to scam Medicare and Medicaid. Nevertheless, we have a clear winner: the Michigan...more
The Massachusetts federal district court is hands-down winner of the August award for strangest regulatory interpretation of the month.
The interpretation came in the context of denial of Omnicare’s summary judgment...more
I.A. Khair of New Jersey ran an ambulance company called K&S Invalid Coach. Presumably, “Invalid” was pronounced IN-va-lid, with the emphasis on the first syllable. Maybe it should have been pronounced in-VAL-id, with the...more
On July 7 the Fourth Circuit invoked Flying Pigs to vacate a lower federal court judgment in a Medicaid false claim case, even though neither the lower court nor any of the parties asked it to.
The case started in 2007,...more
Here’s a riddle: The whistleblower is a former employee of the defendant, with inside knowledge of the operations at the heart of his qui tam suit. How can that inside knowledge be a handicap in pressing his claim? A June...more
For the first time in nearly 20 years the Office of Inspector General (OIG) of the Department of Health & Human Services has issued new guidance on the exercise of its authority to exclude health care providers from...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
Americans are competitive. We generally think there’s nothing better than being number one—and not just at NCAA bracket time.
But being number one isn’t always great. Just ask Dr. Michael Reinstein. He was the...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
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
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
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
Last Monday the Office of Inspector General of Health & Human Services posted a hair-raising report. “Questionable Billing for Medicaid Pediatric Services in California” raises alarming questions about the billing practices...more
All across the country hospitals have been bracing for the scheduled Oct. 1, 2015, transition from ICD-9 coding to ICD-10. It had been scheduled for Oct. 1, 2014, but the Protecting Access to Medicare Act of 2014 delayed it...more
It’s a measure of the backlog in DSH (for Disproportionate Share Hospital) payment appeals that CMS is still issuing rulings for appeals applicable to treatment of patients before October 1, 2004. On April 24 CMS issued...more
The Idaho Medicaid program scored a victory in the United States Supreme Court today, and did it by persuading normally liberal Justice Breyer to enter the conservative tent reliably inhabited by Justices Scalia, Thomas,...more
The February Profile in Courage Award goes to the Office of Inspector General (OIG) of the Department of Health & Human Services. In its very first Advisory Opinion of the year, the OIG has boldly proclaimed that a provider...more
Some questions can’t be answered in a vacuum. That’s the situation when the question is whether an entity wants to be part of the state or separate from it. If the specific issue is whether its board meetings are open to...more
When it comes to the annual Penny-Wise, Pound-Foolish Award, don’t ever bet against the United States Congress. This year, Congress lay back in the weeds until the year was almost over before making its move for the trophy. ...more
Hospitals have long seethed over employees who exploit their inside information to become whistleblowers. There’s generally not much they can do besides seethe unless the employee has some special duty of confidentiality...more