California Physician Loses at Dating Game

A California appellate court has declared physician Visha Dev the loser in his dating contest with Blue Shield Life and Blue Shield California.  The contest arose when the Blues moved for summary judgment in Dev’s action against them for denying three reimbursement claims.  The Blues argued that the date when …

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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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What’s In a Name? Not Much, Says Colo. Federal Court

On March 31 a federal court in Colorado threw out a suit by 80 chiropractors against several national health insurers.  The chiropractors alleged that the insurers violated Colorado law by paying them less than physicians and other health care professionals for the same services. As the judge saw it, the …

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N.Y. High Court Denies Facility Fees for Office Surgery

New York State surgeons who operate in their offices took a hit on March 31, when that state’s highest court upheld a ruling that no-fault insurance companies are not required to pay a facility fee—only the professional fee.  And that’s the case even when the office is formally licensed as an office-based …

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Eighth Circuit Rejects Hospice’s Fifth Amendment Plea

But not the Fifth Amendment plea you’re thinking of.  It was the takings clause, not the self-incrimination clause, that Southeast Arkansas Hospice (SAH) was pleading.  And the Eighth Circuit wasn’t buying it. Medicare caps the annual reimbursement a hospice may receive.  The program requires repayment …

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Suing the Hand that Feeds You

Jeffrey Jacobs alleges that Idaho’s Pocatello Hospital violated the False Claims Act because of physician recruitment contracts that were overly generous to his practice group.  Jeff should know because he was recruited under one of the contracts and worked for the group for three years. According to the …

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