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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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Page 95 of 102

Should Britain’s National Health Service (NHS) Be Doing More to Counter Fraud?

Posted  10/1/15
By Richard Pike and Yulia Tosheva As mentioned in one of our Whistleblower Insider daily updates, the accountants PKF Littlejohn got a lot of press coverage in the UK this week for a report suggesting that the NHS may be losing as much as £5.74 billion per year to fraud. Such a big number obviously provokes a reaction but what can we really conclude about fraud in the NHS and the measures taken to address...

September 23, 2015

The Florida Attorney General announced a $3.5 million settlement with Adventist Health System Sunbelt Healthcare Corporation and Adventist Health System/Sunbelt, Inc. to resolve two suits brought by whistleblowers alleging that Adventist maintained improper financial relationships with physicians and submitted claims to Florida Medicaid for services and items the physicians referred. The settlement resolves claims that Adventist submitted false Medicaid claims and awarded referring doctors based on the number of tests and procedures the doctors ordered. Adventist also entered into separate civil settlements with the federal government, North Carolina and Texas, agreeing to pay more than $115 million. FL.

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 Ari Yampolsky, Mary Inman
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...
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