Federal takedown is considered the largest healthcare fraud in history. The Department of Justice (DOJ) has charged hundreds of medical professionals in what was dubbed “the largest healthcare fraud takedown operation in American history.” The DOJ brought charges against 601 defendants (76 of whom are doctors) for their alleged participation…

If this hospital was targeted by the DOJ, where does that leave everyone else? Today I have a great mystery to present. Last week the U.S. Department of Justice (DOJ) announced a $1.88 million False Claims Act settlement with Genesis Medical Center in Davenport, Iowa. In the settlement, the DOJ…

The DOJ has focused particularly on the payment of kickbacks that induce physicians to prescribe more, or more expensive, opioids. Last week, President Trump unveiled the administration’s new plan to combat the opioid epidemic. In 2016, more than 11 million Americans misused prescription opioids, resulting in 42,000 related deaths and…

Whatever you do, don’t bring patients back for a procedure another day just for the purposes of billing. Determining when to use Modifier 25 can be challenging, and reasonable people can differ about whether it is appropriate in a particular situation. When a patient needs a procedure on the day…

Recent press coverage misleadingly suggested that the ruling was a serious setback to the government’s suit, which is not the case. On Feb. 12, 2018, a federal judge in the Central District of California issued his ruling on the UnitedHealth Group’s (UHG) motion to dismiss the government’s complaint in one…

Those investigating healthcare entities instructed to stick to statutes and regulations The U.S. Department of Justice (DOJ) has issued another memo likely to help healthcare providers avoid potentially unfair government investigations.  The Jan. 25 memo from Associate Attorney General Rachel Brand to the heads of all civil litigation components and U.S.…

The guy either has no idea how the process works or he has mastered the art of lying with statistics. In May 2014, the American Hospital Association (AHA) sued the Secretary of Health and Human Services (HHS) in an attempt to force the government to do something about the ridiculous…

Discussion of a challenge by the DOJ press office regarding reporting on the remarks made by the DOJ’s Michael Granston during a recent HCCA conference. EDITOR’S NOTE: This is a follow-up to David Glaser’s reporting on this policy change in the Nov. 2 edition of the RACmonitor e-News. In a…

New policy changes from DOJ will impact False Claims Act cases moving forward. In announcing a significant policy change, the U.S. Department of Justice (DOJ) said that when it concludes that a qui tam case lacks merit, it will file a motion to dismiss the case rather than allowing the…

In years past, the healthcare industry has seen audit outcomes resulting in multi-million dollar fines for noncompliant billing of drug testing procedures. In some instances, the findings were even more severe, with reports of exorbitant fines for fraudulent billing. On Oct. 19, 2015, news broke of the $256 million payment…