Two Months After Indictment, Medicare Fraud Mastermind and Doctor Plead Guilty

Mark Morad, the man who cooked up a $56 million Medicare fraud scheme, and his accomplice doctor pled guilty yesterday in federal court in Louisiana to various health care fraud charges. According to a September 2014, indictment Mr. Morad directed a massive Medicare fraud scheme through multiple companies he …

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Hospitals and Health Insurers Prodded on Same-Sex and Transgender Issues

In separate actions yesterday, CMS and the New York State insurance regulatory authority took steps to (a) assure equal treatment of same-sex spouses by hospitals and (b) insurance coverage of medically necessary transgender treatment by health insurers. The CMS action took the form of a proposed rule making it …

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AHA Proposes Putting RACs on the Rack

From the Department of Why Didn’t We Think of This Sooner? The American Hospital Association formally proposed last week that Recovery Audit Contractors (RACs) be fined when their denials are overturned on appeal. And this wasn’t just gratuitous advice. The AHA was responding to a plea by the Office of …

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Supreme Court Rejects Whistleblower’s Double-Dip Attempt

On Monday the United States Supreme Court declined to hear Danny Smart’s appeal of the Fifth Circuit’s rejection of his attempt to share in the proceeds of a $5 million settlement of a False Claims Act suit brought by another whistleblower against Texas hospital chain Christus Health. In 2005 Danny blew the …

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It’s Risky to Bill Over 24 Hours in a Day

Remember the old joke about the lawyer standing at the pearly gates?  He says he’s 52.  St. Peter answers, “That’s strange.  According to your time records, you’re 89.” Apparently, home health provider Doris Betts, of Kansas City, Kansas, hadn’t heard the joke—or didn’t get it.  So when the …

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GAO Takes Aim at GPOs

The GAO had drawn a bead on GPOs.  In a report issued yesterday the Government Accountability Office expressed concern over the effect of GPOs (group purchasing organizations) on Medicare rates.  The report recommended that HHS look into the matter and determine whether hospitals are properly reporting their GPO …

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