Catch of the Week — PA Hospital and Health System Pays $12.5 Million to Settle FCA Allegations
Posted 12/14/18
Archive
“Widespread and Persistent” Problems in Medicare Managed Care Burden Patients and Are Potential Violations of the False Claims Act
Posted 10/30/18
Overpayment Rule Decision Doesn't Imperil Risk Adjustment Cases: Mary Inman and Max Voldman in RAC Monitor
Posted 10/19/18
Third Circuit Clarifies the Public Disclosure Bar in United States ex rel. Silver v. PharMerica
Posted 09/7/18
Whistleblower Marc Silver secured a victory from the Third Circuit on September 4, 2018, which held that his action was not blocked by the “public disclosure bar” of the False Claims Act, reversing a lower court that had dismissed his action. The Third Circuit’s opinion appropriately recognizes that a whistleblower can use non-public information as a bridge between public information and allegations of fraud,...
AstraZeneca Settles Seroquel False Claims Action -- Again
Posted 08/9/18
10th Circuit Finds that Doctor’s Judgment is Not Automatically Reasonable and Necessary
Posted 07/20/18
By Poppy Alexander
Top-level heart surgeons work in a rarified world, where few may question their medical judgment. Yet that judgment is not infallible-and its presence is not in itself a protection against False Claims Act liability. The Tenth Circuit recently held as much in United States ex rel. Polukoff v. St. Mark’s Hospital et al., finding that a doctor may be exercising medical judgment while still...
Catch of the Week -- Health Quest Systems and Putnam Hospital Center
Posted 07/13/18
This week, DOJ announced a $14.7 million settlement with NY-based Health Quest Systems, Inc. (Health Quest), and its subsidiary hospital Putnam Health Center (Putnam) based on their submission of inflated and otherwise impermissible claims for payment to Medicare and Medicaid, making Health Quest and Putnam our Catch of the Week.
The settlement resolves allegations stemming from three separate lawsuits bought by...
Question of the Week -- Will New CMS Initiatives Help Curb Fraud and Waste in Medicaid?
Posted 06/27/18
On June 26, 2018 CMS Administrator Seema Verma announced new initiatives to reduce fraud in the Medicaid program. The three new initiatives are to (1) emphasize program integrity in audits of state claims for federal match funds and medical loss ratios (MLRs); (2) conduct new audits of state beneficiary eligibility determinations; and (3) optimize state-provided claims and provider data. These initiatives are meant to...
Catch of the Week -- Signature HealthCARE
Posted 06/15/18
In a major victory for patients and taxpayers alike, DOJ announced an over $30 million settlement with Signature HealthCARE, LLC, a Kentucky-based company accused of overbilling federal healthcare programs for rehabilitation and skilled-nursing services. As a prime example of how valuing profits over patients can lead to fraudulent behavior, Signature HealthCARE wins the title of Catch of the Week.
The settlement...
Michigan Home Health Agency Owner Pleads Guilty to Health Care Fraud Charges
Posted 05/18/18
The owner of a Michigan home health agency pleaded guilty to fraud charges for his role in a scheme involving approximately $8 million in fraudulent Medicare claims for home health services that were procured through the payment of illegal kickbacks. Zahir Shah, 48, of West Bloomfield, Michigan, pleaded guilty to one count of conspiracy to commit health care fraud and wire fraud and one count of conspiracy to pay and...