Hell Hath No Fury Like a CFO Scorned (But His Whistleblower Suit Fails Anyway)

Medicare and Medicaid providers lie awake at night worrying about disgruntled—or worse yet, fired—finance officers filing whistleblower suits. After all, Medicare and Medicaid regulations are notoriously complicated, and False Claims Act (FCA) liability can carry a penalty of three times the amount of each …

[Read more...]

Finally, Some Good News for Halifax–And All Other–Hospitals

It’s been a long time since Orlando’s Halifax Hospital got any good news from the federal court hearing the whistleblower case brought by employee Elin Baklid-Kunz. Earlier this year the hospital had to agree to an $85 million settlement for alleged Stark Law violations. Only a few weeks later the judge hit …

[Read more...]

COURT SLAMS MEDICARE AGENCY, NOTES REPUTATION AS “UNFEELING BUREAUCRACY”

The Department of Health & Human Services’ Provider Reimbursement Review Board (Board) came in for some withering criticism last Friday from the federal court hearing the appeal of University of Chicago Hospital from the dismissal of a Medicare appeal.  The court observed that the public views the Medicare …

[Read more...]

HHS RELABELS INVALIDATED 340B REGULATION AS “INTERPRETATIVE RULE”

Earlier this week HHS came out swinging in the latest round of its battle with the Pharmaceutical Research & Manufacturers of America (PhRMA) over the Affordable Care Act’s provisions on 340B and orphan drugs.  HHS reasserted its long-held position on its website, this time calling it an “interpretative …

[Read more...]

D.C. CIRCUIT SAYS CMS DOESN’T KNOW WHAT’S NEW

On Tuesday of last week the D.C. Circuit Court ruled that the Provider Review Reimbursement Board doesn’t know what’s new.  It reversed the PRRB’s decision, along with the District Court’s decision that upheld it.  In doing so, it threw up its hands (figuratively speaking), repeatedly complaining that it …

[Read more...]

MEDICARE PATIENTS CAUGHT IN TWO-MIDNIGHT RULE CROSSFIRE

Hospitals have been complaining about the two-midnight rule since it was first announced.  But mounting evidence indicates that Medicare patients themselves are suffering badly from the effects of the rule. The rule basically says that in order for a hospital to bill Medicare for an inpatient stay, the …

[Read more...]