Category: Medicare Fraud
Substantial Whistleblower Rewards are Available for Exposing Hospitals that Ignore National Coverage Determinations
False Claims Act (FCA) liability arise when a hospital bills Medicare for items or services that violate CMS’ National Coverage Determinations’ coverage requirements. This was...
Hospital Fraud: It’s Not Just the Money
Hospitals that engage in fraud by encouraging and/or allowing unnecessary procedures, without adequate utilization review; and/or allowing patients to be admitted unnecessarily, are subjecting those...
DOJ Recovers Funds from Physician Who Allegedly Received Kickbacks
Last year, medical device maker CareFusion agreed to pay the government $40.1 million to settle False Claims Act (FCA) allegations that it paid kickbacks to...
DOJ Investigates Alleged Medicare Advantage Risk Scoring Fraud Scheme
In 2003, Congress passed the “Medicare Modernization Act of 2003,” creating Medicare Part C and private Medicare Advantage health plans. According to a relatively recent Center...
DOJ Shows Continued Interest in Ferreting Out Inappropriate Inpatient Care
Oftentimes, potential healthcare whistleblowers inquire about whether the Justice Department has an interest in pursuing particular healthcare fraud schemes. The best indicators of DOJ interest...
Is Your Hospital-Employer Sitting on Known Medicaid or Medicare Overpayments?
In 2009, Congress strengthened the False Claims Act so that employees and the government could bring an action against a provider that knowingly retained an...
United States Supreme Court’s Acceptance of FCA Cases Continues
Every single year, the United States Supreme Court rejects nearly 98% of all cert petitions. However, when it comes to False Claims Act (FCA) cases,...
Shands Healthcare Pays $26 Million to Settle False Claims Related to Inpatient Procedures
In 2006 Shands Healthcare hired Terry Myers and his consulting firm YPRO Corporation to audit six of its hospitals to see if the patients met...
Diagnostic Laboratories and Radiology Pays $17.5 Million to Settle Diagnostic False Claims
Southern California’s largest clinical lab and radiology company for nursing homes paid $17.5 million to resolve allegations that it unlawfully paid kickbacks for referrals of...