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...
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...
This week's Department of Justice "Catch of the Week" goes to the hundreds of medical professionals charged in "the largest healthcare fraud takedown operation in American history." The DOJ brought charges against 601 defendants for their alleged participation in schemes to bill Medicare, Medicaid, TRICARE, and private insurers for medications and treatments that were unnecessary and often never provided. Over a...
On June 26, 2018 CMS Administrator Seema Verma announced new initiatives to reduce 
This week's Department of Justice "Catch of the Week" goes to Healogics, Inc. On Wednesday, the Florida-based operator of hundreds of wound care centers agreed to pay up to $22.5 million to settle claims it violated the 
By Leah Judge
Reaffirming the importance of patient plans of care, the Sixth Circuit recently held that the timing of a physician’s certification of such plans is material to the government’s decision to pay for 
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...
What’s not to like about a doctor waiving a patient’s copayment, or a pharmaceutical company offering a prescription drug assistance program? Turns out there are plenty of reasons to be concerned about such activities. And, as a recently announced 
On May 23, the US District Court in South Carolina 
The Department of Justice today