Lawsuits initiated by whistleblowers under the False Claims Act. Last Wednesday, in a petition to the United States Supreme Court, Intermountain Healthcare (Intermountain), the largest healthcare provider in the Intermountain U.S., made headline legal news by challenging the constitutionality of the False Claims Act (FCA), one of the government’s most…

Federal officials seem wary about their words and their dissemination. At the Health Care Compliance Association’s (HCCA’s) fourth annual Healthcare Enforcement Compliance Conference, top U.S. Department of Justice (DOJ) officials provided an update on current developments related to criminal and civil fraud investigations.  While a future article will focus on…

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…