8th Cir. Rejects Dr.’s Grab-Bag Retaliation Suit

Dr. Alaa Elkharwily lost his job at Albert Lea Clinic, but he didn’t go quietly.  He sued the clinic and eight related organizations and individuals alleging just about everything a terminated doctor can allege in Minnesota: defamation and violation of the Minn. Vulnerable Adults Act, EMTALA, the Minn. …

[Read more...]

And You Thought RAC Audits Couldn’t Get Any Worse

If there’s one thing that unites the hospital industry—even the fiercest competitors—it’s hatred of audits by recovery audit contractors, or RACs.  Why?  For one thing, because RACs operate on a contingency fee basis.  They get to keep a portion of the fees they force providers to repay.  It’s as …

[Read more...]

Site-Neutral Billing Exemptions

The Balanced Budget Bill Act of 2015 has a site-neutral billing provision relating to off-campus hospital outpatient departments (HOPDs).   Those are facilities away from the hospital campus but certified as part of the hospital and therefore qualified to receive a facility fee, like the hospital itself.  …

[Read more...]

No Good Deed Goes Unpunished

Oscar Wilde observed, “No good deed goes unpunished.”  Whistle-blower Michael Cascio discovered the truth of that saying when a federal court threw out his qui tam case against a national wound care provider that partners with some 800 hospitals across the country. Mike and two others alleged that …

[Read more...]

Qui Tam Defendant’s Confidentiality-Breach Counterclaim Fails

What if a whistleblower discloses the protected health information (PHI) of privately insured patients in making the claim that his employer submitted false Medicare claims?  And what if that violates a confidentiality agreement the whistleblower signed with the employer?  Does the employer have a counterclaim …

[Read more...]

Biblical Name No Shield Against Fraud Charge

On May 2 a New Orleans federal jury found that Psalms 23 DME, LLC—its Biblical name notwithstanding--was part of a fraud scheme that illegally billed Medicare $3.2 million. In 2013 the government indicted Psalms 23 owner Tracy Brown and a colleague for a fraud scheme that involved billing Medicare for …

[Read more...]