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 …

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Aetna Wins $37.5 Million for Overbilling Scheme

It’s easy to fall into the habit of regarding self-referrals and kickbacks as strictly a matter of federal law, governed only by the federal Stark Law and Anti-Kickback Statute.  But an April 13 verdict in California provides a vivid reminder that state law also has a role and that private insurers can be as …

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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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Retaliation Claim Survives Though False Claim Act Claim Is False

Roxanne Perkins was employed as a clinical supervisor of prior authorizations therapy at Wellcare Health Plans.  When she returned from a leave of absence, she learned that Wellcare had instituted a new practice of approving all preauthorization requests for durable medical equipment.   She complained that the …

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Bleak House on the Jersey Shore

Remember Jarndyce v. Jarndyce in the Charles Dickens classic Bleak House?  The case drags on for so long that the only winners are the lawyers?  (Not that that’s all bad.) Well, Jarndyce is playing out in a medical staff dispute on the Jersey Shore.  The latest chapter came out on March 14, when the …

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Masked Man Robs Government; Faces 10 Years

The mask itself didn’t raise any suspicions.  After all, the man wearing it—Richard Toussaint--was an anesthesiologist.  But like so many other masked men, he turned out to be a thief.  That’s why on March 4 he was convicted in a Texas federal court on seven counts of health care fraud totaling about $10 …

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