Weeden, C'Reda J
These cases often address whether PBMs have caused false claims to be submitted to government healthcare programs, such as Medicaid, and whether they have engaged in practices that violate the FCA and other related statutes. First, PBMs may violate the FCA by failing to pay reimbursements to ...
Courts have begun to address the use of computer models to predict and process other types of damages claims and found it to be an actionable abuse of computer models. In a recent case, a State court certified a class of GEICO policyholders who alleged that GEICO filtered their PIP claims ...
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On August 30, a California company that operates multiple healthcare providers agreed to pay $5 million to resolve claims that it violated the FCA and the California FCA by causing the submission of false claims to California’s Medicaid program. The government alleged that the company billed for...
to resolve allegations that the company violated the federal and North Carolina FCA The government alleged that the company fraudulently billed Medicaid for DME purportedly provided to individual Medicaid recipients, but the individuals never ordered or received the equipment; in some cases, the supposed...
Piedmont Healthcare has agreed to pay $16 million to the Department of Justice and State of Georgia to settle allegations by a whistleblower that it violated the False Claims Act and the Georgia False Medicaid Claims Act. The Atlanta-based nonprofit healthcare system was accused of improperly ...
(JVHL) Genesis Healthcare Genesis Healthcare Georgia Health Advantage Georgia Medicaid Georgia Medicaid Georgia Medicaid Georgia Medicaid Georgia Medicare Georgia Medicare Georgia Medicare Georgia Medicare Experian Health Payer List Payer Code SYMED SX078 60550 60550 25169 25169 PROSP PROSP 80241 75273 ...
These hospitalizations were drawn from 3 academic centers and 2 community hospitals in Massachusetts and Georgia. Hospitalizations were classified by reviewers as sepsis-positive if there was definite or possible infection and an increase in SOFA score by 2 or more points from baseline as a result ...
Georgia physicians file lawsuit alleging that HMOs have not paid Medicaid claimstext editorEmerging Infectious Diseases