New Guidance on Exclusion

For the first time in nearly 20 years the Office of Inspector General (OIG) of the Department of Health & Human Services has issued new guidance on the exercise of its authority to exclude health care providers from participating in federal health care programs, including Medicare, Medicaid, and Tri-Care.  …

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A Grossly Negligent Claim Isn’t a False Claim

You have to feel sorry for whistleblower Darilyn Johnson.  The former billing clerk thought she had a sure-fire, double-barrel False Claims Act (FCA) case against the medical clinic that fired her. Barrel one was her basic FCA case.  Darilyn could prove that when the allergy clinic filled out its Medicare …

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The Downside of Being Number One

Americans are competitive.  We generally think there’s nothing better than being number one—and not just at NCAA bracket time. But being number one isn’t always great.  Just ask Dr. Michael Reinstein.  He was the nation’s number one prescriber of the antipsychotic clozapine.  How many prescriptions …

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Services that are Worth Less Aren’t Necessarily Worthless

The Sixth Circuit brought a refreshing sense of reality to the government’s sometimes unreal calculation of damages in False Claims Act (FCA) cases.  In this case the government had sought, and won at the trial level, an award of $763,000 against a contractor because of a subcontractor’s underpayment of …

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Finally, A Final Rule on ACA’s 60-Day Repayment Rule

On February 11, 2016, CMS released the much anticipated final rule on the so-called “60-day rule.” The long road to the final rule began when the Affordable Care Act (ACA) established the 60-day deadline for returning Medicare and Medicaid overpayments.  The clock started running from the time an overpayment …

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Criminal Conviction Leaves Defendant Defenseless in FCA Civil Action

Pity Dr. Christina Clardy.  In 2011 she was convicted of health care fraud, sentenced to 135 months in prison, and ordered to pay $16 million in restitution.   Then in 2014 the government added Christina as a defendant in its pending False Claims Act (FCA) civil action against her cronies in the physical …

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