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Medicare Fraud 101





Last Build Date: Tue, 18 Oct 2016 19:39:12 +0000

 



Anti-Kickback Statute Reaches Consultants Who Seek to Improperly Influence Healthcare Providers

Tue, 18 Oct 2016 19:39:12 +0000

The vast majority of False Claims Act settlements involving kickback allegations have been instances where healthcare providers have allegedly received kickbacks for utilizing a manufacturer’s product. Recently, however, there have been a few successful recoveries where the alleged kickback recipient was not the ultimate decision-maker or even healthcare provider. While this is an expansion of […]

The post Anti-Kickback Statute Reaches Consultants Who Seek to Improperly Influence Healthcare Providers appeared first on Medicare Fraud 101.




Government Recovers Millions from Hospital System that Allegedly Wrongfully Retained Medicaid Overpayments for Over 60 Days

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 […]

The post Government Recovers Millions from Hospital System that Allegedly Wrongfully Retained Medicaid Overpayments for Over 60 Days appeared first on Medicare Fraud 101.




Are Medically Unnecessary Tests Driving Growth of In-Office Procedures?

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 […]

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Are Copayment Assistance Nonprofits to Funneling Kickbacks to Patients?

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 […]

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Are Hospitals Pressuring ER Physicians to Inappropriately Admit Patients?

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 […]

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Unproven Promotion and Performance of Stem Cell Treatments

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 […]

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Independent Diagnostic Testing Facilities Fraud

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 […]

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Hospitals’ Stark Law Violations Typically Involve Multiple Medical Groups and Specialties

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 […]

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Relators Receive Nearly $24 Million Reward for Exposing Alleged Kindred Healthcare Fraud

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 […]

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Our Reflection on 2015

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 […]

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