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...
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...
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...
By the C|C Whistleblower Lawyer Team
In a recent interview published in the AARP Bulletin, Attorney General Jeff Sessions opined that “the Department of Justice should continue aggressively pursuing health care fraudsters, either criminally or civilly, and holding them accountable to the fullest extent of the law.” Sessions also expressed concern that “our traditional systems aren’t aggressive enough.” ...
By the C|C Whistleblower Lawyer Team
The 
By the C|C Whistleblower Lawyer Team
AmeriCare Ambulance Service, Inc. and its sister company, AmeriCare ALS, Inc. have reached a $5.5 million settlement with the government, resolving allegations that AmeriCare defrauded Medicare by billing for medically unnecessary ambulance transportation services. According to the government’s complaint, AmeriCare submitted fraudulent claims to Medicare and TRICARE for...