permitting doctors to regularly bill impossible days of services, and by upcoding medical services (using more expensive billing codes than the codes corresponding to the services provided). The settlement resolves claims in twoqui tamsuits, with relators receiving approximately $767,000 of the settle...
On Jan. 29, 1999, the Wall Street Journal reported that a private citizen in Illinois and her attorney were awarded $29.1 million as share of $144 million in fines assessed under the False Claims Act against Blue Cross/Blue Shield of Illinois for Medicare fraud. She had alleged that B...
Ethan P. Davis, Yelena Kotlarsky, and Evan Ennis, King & Spalding LLP OVERVIEW This week’s top False Claims Act developments include: DOJ’s continued emphasis on FCA cases involving Medicare Part C, DOJ’s expanding focus on telemedicine fraud, and a p
“Overbilling Medicare by submitting false claims increases the cost of medical care for all and undermines the integrity of the Medicare program,” Michael A. Bennett, US Attorney for the Western District of Kentucky, stated. “This office will continue to vigorously pursue unscr...
In the MA space, historical enforcement actions taken by both OIG, under their administrative authorities, and DOJ, under the False Claims Act (“FCA”), have related to alleged MA risk adjustment payment inflation schemes. See, e.g., DaVita, Sutter Health, Beaver Medical, Martin’s Point,...
The False Claims Act (FCA) has fast become one of the federal government’s preferred vehicles for recouping monies from providers of services, grant recipients and many others who have only an indirect connection to government funding. With its treble damages, $11,000 per claim penalty, and ...
coding these relevant MCCs at a higher rate.”Id. at *4. Absent any insider information alleging otherwise, the court found that Integra offered only a “possibleexplanation” for the results of its statistical analysis (i.e., that Providence was directing its doctors to falsify claims) and ...
The election of Donald Trump and associated claims of sexism (2024) I remember when universities encouraged informed debate Twitter accuses me of hateful conduct – You be the judge Australian conference regarding false allegations and law reform (31 August 2024) Another Australian domestic viole...
The DOJ claimed that Rite Aid violated the Controlled Substances Act by filling unlawful prescriptions for addictive drugs, as well as the False Claims Act when the chain sought reimbursement from federal healthcare programs for these prescriptions. By Katie Adams Legal, Hospitals Memphis-based ...
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 ...