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Page 15 of 15

Medicare Advantage Plan Loses Members, Responds with Plans to Raise Risk Adjustment Scores

Posted  09/22/15
By Tim McCormack and Molly Knobler (published on The Compliance & Ethics Blog) Modern Healthcare recently reported that although enrollment in the Medicare Managed Care Program (also known as Medicare Advantage or Medicare Part C) has grown by 8% on average since 2010, several top Medicare Advantage Plans are losing membership.  Highmark, Blue Cross and Blue Shield of North Carolina, HealthNow New York, Wellcare...

Tagged in: Healthcare Fraud, Managed Care, Medicare, Upcoding,

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Stark Law Enforcement Trend: Hospital and Individual Physician Settle Allegations of Stark Law Violations and Illegal Upcoding

Posted  09/18/15
By Tim McCormack and Molly Knobler (published on SCCE’s Compliance and Ethics Blog) The Department of Justice’s (“DOJ”) recent string of victories against hospitals that have (allegedly) paid illegal inducements to employed physicians continues.  On September 4, 2015, DOJ settled two False Claims Act (“FCA”) suits with Columbus Regional Healthcare System (“Columbus”) and Dr. Andrew Pippas. ...

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Provider Fraud, Upcoding,

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Constantine Cannon And Department of Justice Continue Joint Pursuit Against California Sleep-Clinic Chain

Posted  09/4/15
By Jessica T. Moore Constantine Cannon LLP has filed an amended complaint on behalf of a whistleblower alleging multi-faceted fraud on the part of Bay Sleep Clinic and its owners and operators, and billing company Access Medical Consultants.  The filing in United States ex rel. Dresser v. Qualium Corp., et al, Civil Action No. 12-1745 in the Northern District of California, comes on the same day the United...

Tagged in: Government Decision, Healthcare Fraud, Improper Medical Facility, Improper Medical Personnel, Laboratory and IDTF, Medicare, Whistleblower Case,

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DOJ Gives Major Shoutout To Whistleblowers In $450M DaVita False Claims Act Settlement

Posted  06/26/15
By Gordon Schnell On Wednesday, Denver-based provider of dialysis services DaVita Healthcare Partners, Inc. agreed to pay $450 million to resolve charges it violated the False Claims Act by purposely creating and then billing the government for unnecessary waste in administering the drugs Zemplar and Venofer to dialysis patients.  DaVita is the largest provider of dialysis services in the US with dialysis clinics...

Tagged in: Dosage Fraud, FCA Federal, Lack of Medical Necessity, Medical Billing Fraud, Medicare, Pharma Fraud, Whistleblower Case,

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DOJ Catch Of The Week -- PharMerica Corporation

Posted  05/15/15
By the C|C Whistleblower Lawyer Team This week's Department of Justice "catch of the week" goes to PharMerica Corporation, an organization of long-term care pharmacies that dispense medications to residents of nursing homes and skilled nursing facilities across the country.  Yesterday, PharMerica agreed to pay $31.5 million to settle charges it violated the Controlled Substances Act by dispensing Schedule II...

Tagged in: Catch of the Week, Lack of Medical Necessity, Pharma Fraud, SNF,

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DOJ Catch of the Week -- Health Management Associates

Posted  05/8/15
By the C|C Whistleblower Lawyer Team This week's Department of Justice "catch of the week" goes to Health Management Associates Inc.  Yesterday, the hospital chain and 14 hospitals it previously owned and operated, along with 2 other hospitals, agreed to collectively pay $15.69 million to settle whistleblower charges they violated the False Claims Act by seeking and receiving Medicare reimbursement for Intensive...

Tagged in: Catch of the Week, FCA Federal, Lack of Medical Necessity, Whistleblower Case,

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DOJ Catch Of The Week -- Institute For Cardiovascular Excellence

Posted  01/9/15
By the C|C Whistleblower Lawyer Team This week's Department of Justice "catch of the week" goes to Florida cardiologist, Dr. Asad Qamar, and his physician group, the Institute for Cardiovascular Excellence.  On Monday, the DOJ intervened in two whistleblower lawsuits alleging Qamar and his group billed Medicare for medically unnecessary peripheral artery interventions and paid kickbacks to patients by waiving...

Tagged in: Catch of the Week, FCA Federal, Lack of Medical Necessity, Provider Fraud, Whistleblower Case,

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Buying Blind – New Study Shows Continued Lack of Transparency in Healthcare Pricing

Posted  02/28/13
By Gordon Schnell It has been talked about for years as a way to rein in the runaway costs of healthcare in this country -- making price matter to the consumer.  That is how it is with every other kind of purchase.  Whether it is a car, a house, a college education, a new pair of sneakers, or even a quart of milk, virtually everyone weighs heavily into their purchase decision what it is ultimately going to...

Tagged in: Bundling and Unbundling, Healthcare Fraud,

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Scooter Store Caught Cheating the Government Out of Millions

Posted  01/24/13
By Marlene Koury It seems like such a wholesome company.  They have those nice commercials where elderly folks are scooting to and fro on their power-mobility devices.  It would seem that only an honest and trustworthy company would dedicate itself to caring for the needs of the elderly in this way.  But, according to an independent auditor, The Scooter Store – the purveyor of these fine commercials and the...

Tagged in: Lack of Medical Necessity, Provider Fraud,

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