Court Rejects Qui Tam Attack on Standard On-Call Contract

On June 10 the Third Circuit affirmed a lower court’s dismissal of a physician’s qui tam action against Pottstown Memorial Medical Center (PMMC) for violating the Anti-Kickback Statute (AKS) and False Claims Act (FCA).  And it’s a good thing because the basis of his claim was an on-call coverage arrangement …

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False Claims Charges vs. Eye Clinic Sufficiently Specific

Michael Sorenson is an optometrist formerly employed by Outreach Diagnostic Clinic.  After he quit, he filed a False Claims action against the eye clinic and the two doctors who owned it.  He alleged that the clinic routinely billed Medicare for tonography (i.e., eye pressure) tests that were never performed and …

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Attorneys Pay Heavy Price for Block-Billing

Lawyers are aware of the increasing sensitivity—and hostility—of clients to block-billing: lumping more than one activity into a single time entry.  A new Fifth Circuit decision shows that courts can be equally sensitive—and hostile—to the practice.  The court upheld an award of $739,000 in attorneys’ …

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Supremes Hear Argument on Implied Certification Theory

On April 19 the U.S. Supreme Court heard oral argument in Universal Health Services v. U.S. ex rel. Escobar.  That’s the case in which the First Circuit upheld a whistleblower suit brought against a mental health clinic that had treated their daughter.  Their theory is that the clinic’s reimbursement …

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Texas-Size Sentences for Texas-Size Medicare Fraud

They do things big in Texas.  The latest example is the punishments being handed out for a Medicare fraud scheme at Riverside General Hospital in Houston. Let’s start with the fraud scheme.  It was Texas-size, too, resulting in a whopping $158 million in false Medicare claims for partial hospitalization …

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OK to Exaggerate How Long Patients Need Device

Today’s riddle:  Why would a federal court approve a medical device manufacturer’s practice of persuading physicians to exaggerate the period of time Medicare patients need their devices?  The answer is so simple that you’ll be embarrassed that you didn’t get it right away. Whistleblower Jeffrey …

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