Healthcare Fraud
This archive displays posts tagged as relevant to healthcare fraud.
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Sleep-Disorder Fraud
Posted 09/22/15
Can one commit fraud while sleeping? Sort of.
Increasing numbers of troubled sleepers are seeking diagnosis and treatment of chronic sleep disorders that affect more than fifty million Americans. The significant growth in sleep medicine over recent years brings increasing opportunities for the unscrupulous to engage in fraudulent services and billing
The most common method of diagnosing sleep disorders is a...
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...
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. ...
September 9, 2015
Constantine Cannon attorney Jessica Moore was quoted in the San Jose Mercury News article, Saratoga: Owners of Bay Sleep Clinic accused of defrauding Medicare. Click here to read the article.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...
The AseraCare Trial Gears Up and Creates Ripples for Larger Hospice Industry
Posted 08/6/15
By Mary Inman and Ari Yampolsky
The issue teed up in the Government's trial against AseraCare cuts to the core of Medicare’s hospice benefit. A Medicare beneficiary is eligible for hospice care only if two doctors certify that she is “terminally ill.” This means that her illness will lead to her death within six months, if the illness runs its normal course. Because Medicare beneficiaries who choose...
As AseraCare Trial Begins, Judge Narrows What Government Can Present to the Jury
Posted 08/5/15
by Mary Inman and Ari Yampolsky
Yesterday's AseraCare trial began like all others with the empaneling and swearing in of the jury. However, unlike juries in other False Claims Act trials, this jury will only be provided with a narrow slice of the evidence. Judge Bowdre has divided the trial into phases and, in an unusual move, has severely restricted what the Phase One jury will consider.
Although there are...
Congress Highlights Medicare Part D Plans’ Failure To Prevent Fraud
Posted 07/16/15
Fraud in the Medicare Part D prescription drug program is getting the attention of not only the Department of Health and Human Services’ Office of the Inspector General (HHS OIG) but also watchdogs on Capitol Hill. On Tuesday, July 14, 2015, the House of Representatives’ Committee on Energy and Commerce held a hearing to examine two recent reports from HHS OIG examining improper spending in the Medicare Part...
Have We Reached the Final Round In the Government's Tuomey Kickback Case?
Posted 07/10/15
The United States won another round in its now almost eight year battle to hold South Carolina-based Tuomey Healthcare System liable for paying doctors illegal kickbacks. The litigation has been long and procedurally complex, but at bottom, the Government has alleged, and the jury has found, that Tuomey gave a group of doctors unreasonably lucrative employment arrangements to get them to send their patients to...