The mask itself didn’t raise any suspicions. After all, the man wearing it—Richard Toussaint–was an anesthesiologist. But like so many other masked men, he turned out to be a thief. That’s why on March 4 he was convicted in...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
What if a store clerk sells a product that, unbeknownst to him, is illegal? Can the clerk be convicted of a crime, despite not knowing the product was illegal and not intending to sell an illegal product? On January 14,...more
As we reported, the Centers for Medicare & Medicaid Services (CMS) posted revised instructions and application forms on January 22, 2016, for health care providers unable to meet electronic health records (EHR) “meaningful...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
The Centers for Medicare & Medicaid (CMS) expect 209,000 health care providers to face Medicare payment reductions for failing the electronic health records (EHR) “meaningful use” requirements in 2014. CMS puts the estimated...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
Yesterday the Government Accountability Office (GAO) requested that Congress order Health & Human Services to equalize Medicare payments for the same services, whether provided in a physician office or in a hospital...more
When CVS fired store manager Tonia Ramos in 2011, it offered her its standard severance agreement that included a broad release of waivable claims, including claims under Title VII, but explicitly preserving the right to...more
A new 2016 Medicare physician payment rule allows hospitals and other provider institutions to make payments to physicians for the purpose of enabling them to employ nonphysician practitioners, such as nurse practitioners and...more
A September 29 ruling by the New Jersey Supreme Court effectively makes a health facility liable for the professional negligence of a medical staff member who doesn’t have malpractice insurance or who has insurance that...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
Health care institutions in Kentucky may want to take a fresh look at their patient arbitration provisions, in light of a September 24 decision by the Kentucky Supreme Court. Out-of-state institutions may want to take a...more
RHP hired Schindler to practice neurosurgery. Two years later, he developed various back-related physical issues that interfered with his ability to perform surgery. RHP took steps to accommodate him so that he could...more
For many years, the United States Court of Appeals for the Third Circuit was out of step with its sister Courts of Appeal when it came to the issue of suing health insurance companies for failing to cover the medical expenses...more
The Stark Law generally prohibits physicians from referring Medicare and Medicaid patients to facilities in which they have an ownership interest. There used to be a “whole hospital exception” excluding entire hospitals (as...more
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
Before September 11 the Third Circuit Court of Appeals had been out of step with its sister federal circuits when it came to the right of hospitals, physicians and other health providers to sue health insurers that failed to...more
Physician-owned hospitals cherry-pick well-insured patients, disfavor Medicaid and minority patients, and charge more that their nonprofit counterparts, right? Wrong, says a new study published on September 2 by respected...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