It turns out that not everyone wants to be on television. New York-Presbyterian found that out the hard way.
Back in 2011 the hospital allowed a television camera crew inside treatment areas to record footage for the...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
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
It’s easy to fall into the habit of regarding self-referrals and kickbacks as strictly a matter of federal law, governed only by the federal Stark Law and Anti-Kickback Statute. But an April 13 verdict in California provides...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
You have to hand it to Kansas federal judge Daniel Crabtree. He played it completely straight in his April 7 decision rejecting the claim by Suture Express that two national medical supply distributors were guilty of...more
The Indiana Health Department sent a team to the Nightingale home health care and hospice group, in response to complaints. When CMS received the team’s report, it notified Nightingale that its Medicare certification was...more
On March 31 a federal court in Colorado threw out a suit by 80 chiropractors against several national health insurers. The chiropractors alleged that the insurers violated Colorado law by paying them less than physicians and...more
The defendants aren’t in the health care business, but their April 1 victory in the Tenth Circuit has implications for defendants in all lines of business. That’s why the U.S. Chamber of Commerce weighed in with an amicus...more
A federal court in Alabama dealt a blow to the theory that in matters of medical judgment, a false claim action can rest on expert opinion evidence alone.
A patient is eligible for hospice if the prognosis is life...more
New York State surgeons who operate in their offices took a hit on March 31, when that state’s highest court upheld a ruling that no-fault insurance companies are not required to pay a facility fee—only the professional fee....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
On March 24 the Federal Trade Commission issued an order temporarily putting on hold its hearing on the Cabell Huntington Hospital’s proposed acquisition of St. Mary’s Medical Center and Pallottine Health Services....more
The federal government has made no secret of its concern over what is invariably described as an “opioid epidemic” sweeping the country. Nor is it a secret that the government sees prescribing physicians—especially primary...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
Michigan is just the latest state to consider legislation requiring hospitals to post their chargemasters on-line. Mich. Sen. Bill 147. These proposals have been popping up since 2013, when Time magazine devoted a full issue...more
If it’s an election year, it must be time for someone in Congress to propose a tort reform bill and to come up with a snappy acronym—the more tortured, the better.
And Rep. Trent Franks (R-Ariz.) has done just that, with...more
Remember Jarndyce v. Jarndyce in the Charles Dickens classic Bleak House? The case drags on for so long that the only winners are the lawyers? (Not that that’s all bad.)
Well, Jarndyce is playing out in a medical staff...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
In one of the more unexpected developments in recent Congressional history, a House Ways & Means Committee vote relating to the Affordable Care Act (ACA) turned partisan. Astonishingly, all the Republicans voted one way; all...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
From the founding of the Republic, Americans have joked about the poor handwriting of physicians. Well, all the Americans except the ones who got the wrong medicine because pharmacists misread handwritten prescriptions....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
But not the Fifth Amendment plea you’re thinking of. It was the takings clause, not the self-incrimination clause, that Southeast Arkansas Hospice (SAH) was pleading. And the Eighth Circuit wasn’t buying it....more