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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…
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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…
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A recent False Claims Act case highlighted a range of perils. Scripps Hospital recently paid $1.5 million to resolve a False Claims Act (FCA) case. There are several lessons to be learned from the complaint and settlement.   First, when an FCA case is first announced or settled, people typically turn to…
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A False Claims Act case pits a prominent health system against its EHR software provider. Over the last many years, healthcare providers have been financially incentivized to purchase electronic health records (EHR) software. These programs can cost upwards of $25,000 to $50,000, and, sometimes are renewable every year. In other…
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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.…
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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…
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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…
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The lawsuit was filed as an alleged violation of the federal False Claims Act. A recently unsealed federal whistleblower lawsuit alleges that dozens of Indiana hospitals engaged in a pattern of overcharging patients for their electronic medical records (EMRs), according to a recent report in Becker’s Hospital Review. The report…
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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…
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Recent articles have described the regulatory complexity surrounding signatures and credentials in the world of healthcare. There’s a practical question associated with this: How do you train people to comply with a best practice without mischaracterizing the state of a law?  This question is really important. Perhaps my favorite activity as a lawyer…