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
Rebecca was a nurse at North Cypress Medical Center, in Texas. Back in 2011 she was treated for an eating disorder at Timberline Knolls Residential Treatment Center, in Illinois. When she sought reimbursement under the...more
On July 28 the Office of Inspector General (OIG) of Health & Human Services gave its blessing to a health system’s lease of employees to a related psychiatric system. Under the arrangement the system would also provide...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
Remember the notorious “death panel” debate of 2009? Congress was considering a proposal to pay doctors for end-of-life counseling. Former vice presidential candidate Sarah Palin led the attack on the proposal, claiming...more
In 2012 Nikita Montgomery was hired to work in the Planned Parenthood department of a county hospital. In accepting the employment, she told the hiring manager that she had left her employment at another family planning...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.
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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
Generally, when a doctor is convicted for fraud, the misdeeds are limited to a single category of fraud. Maybe the doctor charged for procedures that weren’t performed; maybe there were kickbacks for referrals; or maybe...more
A consortium of hospitals from across the country has delivered a letter to Congressional leaders, urging them to preserve the federal 340B program in its present form. Neither the content nor the timing of the letter was...more
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
Sen. Lamar Alexander, chairman of the Senate Health, Education & Labor Committee, has issued letters to the Department of Health & Human Services and a number of federal agencies, requesting information about their procedures...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
One of the first healthcare lessons we learn as children is that good medicine doesn’t necessarily taste good. In fact, sometimes the best medicine tastes pretty bad....more
On May 5 the Fourth Circuit reversed a District Court decision upholding Lloyd’s of London’s rescission of a Maryland surgeon’s disability policies. Lloyd’s had rescinded the policies because the surgeon gave false answers...more
Here’s an interesting riddle. When a plaintiff sues a hospital for an injury, why would the hospital insist the injury was caused by malpractice? Even more puzzlingly, why would the plaintiff insist she was not the victim...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
On April 20, 2015, the Office of Inspector General (OIG) of the Department of Health & Human Services issued new compliance guidance for governing boards of hospitals and other health care organizations....more
On Wednesday of this week, the federal court for the Southern District of New York rejected Fox’s plea to spare it from the $169,000 bill submitted by the white shoe law firm that successfully defended Managed Health Care...more
We don’t normally think of American Hospital Association and the Federation of American Hospitals as friends. After all, the AHA represents nonprofits, while the FAH represents for-profits. ...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
A federal court in Kentucky ruled on March 17 that Ashland Hospital had forfeited $10 million of insurance coverage because it was late in notifying its insurance company of the claim....more
It’s common to use the term “cost of health care” to mean the price of health care. But there is a difference—often a huge difference....more