September 17, 2020
By Mary Inman, Esq. and Max Voldman, Esq. New Settlement Demonstrates New Fraud Type in Medicare Advantage program – Inflation of bids
Two payers allegedly inflated their bids. Earlier this month, two Independence Blue Cross (IBC) subsidiaries in Pennsylvania agreed to pay $2.25 million to resolve allegations that they defrauded the Medicare Advantage (MA) program and violated the False Claims Act by improperly inflating their bids. Medicare Advantage, also known as Medicare…
By Mary Inman, Esq. and Max Voldman, Esq.
The government has been cracking down on pharmaceutical companies’ nefarious use of charities to steer Medicare patients toward more expensive drugs, costing taxpayers millions of dollars. The schemes take a few forms, but the fact pattern generally goes something like this: a pharmaceutical company sets up a charity (or makes…
July 30, 2020
By Mary Inman, Esq. and Max Voldman, Esq. A Wolf in Sheep’s Clothing: The Government’s Latest Stand Against Patient Kickbacks Disguised as Charity
The U.S. Department of Justice (DOJ) is deeply committed to combating drug companies’ pervasive practice of disguising patient kickbacks as charity. Most recently, Boston-based prosecutors reached a $51 million settlement with Swiss pharmaceutical giant Novartis, resolving allegations that Novartis coordinated with charitable foundations to steer Medicare patients to its drugs…
July 16, 2020
By David M. Glaser, Esq. The Perils of Email
Email is a wonderful thing. As a kid, or even as an adult, I rarely wrote letters because the act of addressing an envelope was too much for me. (Please don’t judge me too harshly!) But I whip off emails to friends all the time. While I love email, it…
July 9, 2020
By Bryan Nordley For Novartis Pharmaceuticals, Settling Allegations of Improper Payments Came at an Over $642 Million-dollar Price.
The dual settlements represent the Department of Justice’s continued crackdown on possible False Claims Act violations. Novartis Pharmaceuticals Corporation reached an over $642 million-dollar agreement to resolve claims of violating the False Claims Act (FCA). The company based out of East Hanover, New Jersey was involved in two settlements. The first…
March 5, 2020
By Sean M. Weiss, CEMA, CMCO, CPMA, CPC-P, CMPE, CMPM, CPC-P Determining When Copay Waivers Are Allowed
More education is needed to explain when waivers are allowed. The age-old question of “can we offer cash-pay discounts, professional courtesy, and/or the waiver of co-payments or deductibles?” continues to be as relevant today as it was two decades ago. There have been a lot of opinions shared over the…
September 19, 2019
By David M. Glaser, Esq. Court decision upholds provider sovereignty over determinations of medical necessity
Ruling focused on key hospice admission. Last week, the 11th Circuit (the federal appeals court for the Southeastern United States) issued a decision in the AsceraCare case. We have been waiting for this decision since the case was argued two and a half years ago. The key question in…
By Glenn Krauss, RHIA, BBA, CCS, CCS-P, CPUR, CCDS, C-CDI, PCS, FCS, C-CDAM
The allegations in the case focused on CCs and MCCs. EDITOR’S NOTE: This story appeared Aug. 20, 2019, in the ICD10monitor news. A Texas federal judge recently dismissed a False Claims Act lawsuit alleging that Dallas-based Baylor Scott & White Health overbilled Medicare by improperly upcoding claims. The whistleblower lawsuit, filed…
June 6, 2019
By Mary Inman, Esq. and Max Voldman, Esq. Intermountain Drops Supreme Court Challenges to False Claims Act with Settlement of Whistleblower Suit
Healthcare system drops petition to the U.S. Supreme Court to challenge the constitutionality of the whistleblower provisions of the False Claims Act Last month, several media outlets reported that Intermountain Health, a Utah-based health system that operates 22 hospitals and dozens of group clinics, urgent care facilities, a home healthcare…
By Mary Inman, Esq. and Max Voldman, Esq.
Allegations were made of kickbacks in the form of co-pay waivers. Late last month, US WorldMeds, a pharmaceutical manufacturer, agreed to pay the U.S. Department of Justice (DOJ) $17.5 million to resolve two whistleblowers’ claims that it violated the False Claims Act (FCA) by paying kickbacks to patients and doctors…
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