Medicare Appeal Proposal Falls Far Short of Court Mandate

For years the hospital industry has been in an uproar over the mountainous backlog of Medicare claim appeals.  Current estimates are that a whopping 650,000 claims are at the Administrative Law Judge level awaiting adjudication.  Worse yet, the backlog has been growing at a dizzying rate, with requests for ALJ …

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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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