September 19, 2019
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…
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
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…
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…
April 18, 2019
MedStar Health Pays $35M to Settle Kickback Claims
Payments were allegedly paid under the guise of professional service agreements. MedStar Health, a health system in Maryland and Washington, D.C., and two of its hospitals have settled allegations that they violated the False Claims Act by engaging in conduct that violated the Anti-Kickback Statute. The settlement, which is not…
Filing focuses on generic drug costs levied by pharmacies absorbed by the pharmacy giant. In 2013, J. Douglas Strauser, a pharmacist, filed a whistleblower lawsuit against Stephen L. LaFrance Holdings Inc. and Walgreens, alleging that they overcharged Medicaid for generic drugs by not giving the government the best price. Stephen…
January 24, 2019
Intermountain Healthcare Seeks to Dismantle the DOJ’s Chief Civil Fraud Enforcement Tool
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…
December 13, 2018
Actelion Pharmaceuticals Pays $360 Million to Settle Allegations of Kickbacks to Patients: Lessons Learned
Medicare patients were specifically excluded from the program. The U.S. Justice Department announced on Dec. 6 that Actelion Pharmaceuticals has agreed to pay $360 million to resolve allegations that it paid kickbacks by giving contributions to the Caring Voice Coalition, a charitable organization that then used the contributions to pay…
November 15, 2018
Mixed Messaging from DOJ at HCCA Conference for Second Straight Year
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…
August 30, 2018
Integra Med Analytics Files Whistleblower Lawsuit against Providence Health & Services and J.A. Thomas and Associates
Filing marks shift in nature of healthcare litigation of this nature. The whistleblower cases I report on for RACmonitor typically are brought by the quintessential whistleblower – a healthcare industry insider who has observed first-hand fraud perpetrated by his or her employer and who, having brought the matter to the…
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Allen Jost, PhDAlvin Gore, MD, CHCQM and Cathi Charlberg, LVN, CHCQMAmanda Gilliland, RN, BSNAndrew B. Wachler, Esq.Andrew H. Hughes, MD and Charles Locke, MD, CHCQM-PHYADVAndrew Wachler and Kaitlin NucciAndrew Wachler, Esq., and Sarah Hillegonds, Esq.Angela Phillips, PTBarbara Vandegrift, RN, BSN, MABecky Rodrian, CPC, CEMC, CBCS, MBSBrian T. LandryChristina Panos, RHIA, CTRChristopher Halleman, DOChristopher J. Laney, Esq.Chuck BuckDaniel Zirkman, MDDavid M. Glaser, Esq.Denise Nash, MD, CCS, CIMDheeraj Mahajan, MD, FACPDuane Abbey, PhD, CFPEdward Roche, PhD, JDElizabeth C. Dunbar, MD, MBA, FACEP, CHCQM-PHYADVEllen Fink-Samnick MSW, ACSW, LCSW, CCM, CRPErica E. Remer, MD, FACEP, CCDSErin Diesel Roumayah, Esq.Frank D. Cohen, MPA, MBBGlenn Krauss, RHIA, BBA, CCS, CCS-P, CPUR, CCDS, C-CDI, PCS, FCS, C-CDAMGloryanne Bryant, RHIA, RHIT, CCS, CCDSGreg FordHolly Louie, RN, CHBMEJ. Paul Spencer, CPC, COCJanelle Ali-Dinar, PhDJeffrey D. Lehrman DPM, FASPS, MAPWCAJessica Forster, Esq.John K. Hall, MD, JD, MBA, FCLM, FRCPCJuliet B. Ugarte Hopkins, MD, CHCQM-PHYADVKathleen K. Borchard, BSN, RN-ACMKathy Seward, MD, CHCQM-PHYADVKim T. Charland, BA, RHIT, CCSKnicole C. Emanuel Esq.Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-approved ICD-10-CM/PCS trainerLaurie M. Johnson, MS, RHIA, FAHIMALori O’Hara, MA, CCC-SLPMark SpiveyMarvin D Mitchell, RN, BSN, MBAMary Beth Pace, RN, BSN, MBA, ACM, CMACMary Inman, Esq. and Max Voldman, Esq.Matthew AlbrightMax Voldman, Esq.Melinda Battaile, MD, FHM, MMCI, CHCQM-PHYADV, CCDSMichael A. Salvatore, MD, FACPMichael Rosen, Esq.
