Orthopedic Patient Doesn’t Have a Leg to Stand On

It’s well known that Medicare, Medicaid and commercial insurers hate the ever-increasing trend of hospitals buying facilities and practices and then charging provider-based (i.e., higher) rates than the facilities and practices charged before the acquisition. Julia Zeman doesn’t like it, either.  Why?  …

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CFO’s Thirst for Wine Club Invitation Costs Hospital Millions

You can’t make this stuff up.  Last Monday a federal court in Rhode Island ordered two insurance companies to pay a $30 million claim by hospital management company Lifespan Corp.  Lifespan filed the claim after being ordered in an earlier suit to pay that amount to New England Medical Center and the …

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Where All the Hospitals Are Above Average

Last Thursday The Joint Commission released a report, America’s Hospitals: Improving Quality & Safety, identifying “top performers” among hospitals across the nation. According to the report, 1,224 hospitals are “top performers.”  The report was released in Chicago – not Lake Wobegon – but …

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Seventh Circuit: No Fraud in Billing Medicaid More than Private Insurers for Drugs

Last Wednesday the Seventh Circuit affirmed the dismissal of a whistleblower suit brought by a pharmacist against his former employer, the Shopko pharmacy chain, for what he alleged was fraudulent billing of Medicaid by Shopko stores across the nation. Carl Thulin’s theory was imaginative—and complicated.  …

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November Generality-in-Pleading Award

We’re only one-third of the way through the month of November, but we already have a winner of November’s Generality-in-Pleading Award.  The hands-down winner is Dr. Warren Troxler, whose False Claims Act whistleblower suit against his former employer, Warren Clinic, was thrown out of court last Wednesday for …

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HIPAA Isn’t the Only Standard for Confidentiality

Nobody knows better than hospitals how difficult, complicated and expensive it is to comply with the confidentiality requirements of HIPAA (for Health Insurance Portability & Accountability Act).  And hospitals and their lawyers are well aware of HIPAA’s provision preempting all contrary state laws. But …

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