2016 Nerve-of-a-Burglar Award

Competition for the 2016 Nerve-of-a-Burglar Award was fierce, with health care providers constantly coming up with new and different ways to scam Medicare and Medicaid.  Nevertheless, we have a clear winner: the Michigan physician charged with an array of fraudulent Medicaid schemes that included ordering …

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Another Blow to Medicare “Self-Disallowance” Rule

You can tell by its name that you won’t like the Medicare “self-disallowance” rule.   The federal district court for D.C. didn’t like it, either, and gave a group of Banner Health hospitals summary judgment that the rule was invalid as applied to the group’s appeal. Medicare pays hospitals under the …

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The Law Doesn’t Forbid Submitting False Claims

An Eighth Circuit decision provides a reminder that the False Claims Act doesn’t forbid submitting false claims: it forbids knowingly submitting false claims.   That made all the difference in an appeal of summary judgment in favor of a physician group that, according to the relator, failed to comply with …

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What’s In a Name? Or, the Importance of Emphasis

I.A. Khair of New Jersey ran an ambulance company called K&S Invalid Coach.  Presumably, “Invalid” was pronounced IN-va-lid, with the emphasis on the first syllable.  Maybe it should have been pronounced in-VAL-id, with the emphasis on the second syllable.  Why?  Because by running the company Khair …

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Where’s the Crime in Providing Free Medical Care?

Can it be a crime to provide free medical care?  That’s the question presented by a post-conviction motion by the so-called King of Nursing Homes, Dr. V. Kuchipudi. Dr. K was convicted on nine counts of violating the Anti-Kickback Statute (AKS) and one count of conspiracy for an arrangement with now-defunct …

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When Inside Knowledge Is a Handicap to a Whistleblower

Here’s a riddle: The whistleblower is a former employee of the defendant, with inside knowledge of the operations at the heart of his qui tam suit.  How can that inside knowledge be a handicap in pressing his claim?  A June 21 decision by a Massachusetts federal court provides an answer and an …

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