Last Build Date: Tue, 13 Sep 2016 14:53:45 +0000
Tue, 13 Sep 2016 14:53:45 +0000
Recently, the Justice Department announced a first-of-its-kind settlement involving allegations that a health system violated the False Claims Act by retaining Medicaid overpayments for more than 60 days after identifying that overpayments were made. This $2.95 million settlement with Mount Sinai Health System was the first settlement involving the Affordable Care Act provision that created […]
Wed, 24 Aug 2016 19:57:06 +0000
In a recent Wall Street Journal article titled, “In-Office Testing by Doctors Lifts Medicare Costs,” it was revealed that a sizeable chunk of the Medicare dollars are now going to physicians who utilize newly minted in-office medical devices. In fact, the WSJ’s analysis of recently released Medicare billing data showed that four of the top […]
The post Are Medically Unnecessary Tests Driving Growth of In-Office Procedures? appeared first on Medicare Fraud 101.
Fri, 01 Jul 2016 15:51:47 +0000
In recent years, the federal government has reviewed the issue of copayment assistance organizations that purport to help Medicare and Medicaid beneficiaries with their pharmaceutical copayments, but has not yet taken any public enforcement action to our knowledge. Now, the media seems to be taking a closer look, as seen in a recent Bloomberg article […]
The post Are Copayment Assistance Nonprofits to Funneling Kickbacks to Patients? appeared first on Medicare Fraud 101.
Fri, 24 Jun 2016 15:37:38 +0000
Over the last few years, the government has devoted substantial resources to pursue hospitals that inappropriately admit patients to inpatient stays. This month, the government intervened after initial declaration in a qui tam case against 14-hospital health system Prime Healthcare. The lawsuit included allegations that senior management would: criticize Emergency Department doctors and demand their […]
The post Are Hospitals Pressuring ER Physicians to Inappropriately Admit Patients? appeared first on Medicare Fraud 101.
Thu, 03 Mar 2016 16:35:08 +0000
In October 2015 the FDA issued the following fraud warning on stem cell therapies: FDA has not approved any stem cell-based products for use, other than cord blood-derived hematopoietic progenitor cells (blood forming stem cells) for certain indications. The appropriate, clinically proven and beneficial use of stem cell therapies is updated and published by reliable […]
The post Unproven Promotion and Performance of Stem Cell Treatments appeared first on Medicare Fraud 101.
Tue, 23 Feb 2016 20:06:34 +0000
An Independent Diagnostic Testing Facilities (IDTF) is a facility that is separate and independent from a hospital or physician office, where patients go to obtain certain x-rays, scans, and other imaging and diagnostic tests that are ordered by treating physicians. For more than a decade, various HHS-OIG reports and advisory opinions have highlighted IDTF fraud […]
Fri, 19 Feb 2016 18:49:37 +0000
The physician self-referral law, or Stark Law, generally forbids a hospital from billing Medicare for certain services referred by physicians who have a financial relationship with the hospital unless that relationship falls within an enumerated exception. When faced with concerns of possible Stark Law violations, some hospitals have been too quick to seek cover under […]
The post Hospitals’ Stark Law Violations Typically Involve Multiple Medical Groups and Specialties appeared first on Medicare Fraud 101.
Thu, 28 Jan 2016 20:37:24 +0000
In January 2016, Kindred Healthcare and its subsidy Rehab Group agreed to pay the federal government $125 million to resolve allegations that they knowingly causing skilled nursing facilities (SNFs) to submit false claims to Medicare for rehabilitation therapy services that were not reasonable, necessary and skilled, or that never occurred. The relators received a whistleblower […]
The post Relators Receive Nearly $24 Million Reward for Exposing Alleged Kindred Healthcare Fraud appeared first on Medicare Fraud 101.
Tue, 05 Jan 2016 18:10:31 +0000
Our law firm desires to positively impact patient care through our courageous clients, expose wrongdoing and recover tax monies for the citizens of our country. We feel gratified when looking back at 2015: Our clients not only contribute to the recovery of stolen tax dollars, but they cause and continue to cause the stoppage of […]
Fri, 18 Dec 2015 18:36:05 +0000
According to the Defense Department, Tricare paid $1.75 billion for compounded drugs during its 2015 fiscal year—an astounding 18 times the amount paid in 2012. In 2015, compounded drugs represented 19% of Tricare’s $9.14 billion prescription drug budget, up from a miniscule 1.3% in 2012, according to DOD. United States Attorney Lee Bentley, of the […]
The post Are Compounding Pharmacies Bribing Their Way Into Our Service Members’ Medicine Cabinets? appeared first on Medicare Fraud 101.