CMS Report Blasts Provider Directory Errors

A new report by CMS echoes many patients in criticizing Medicare Advantage (MA) online provider directories for containing too many errors.  “Online Provider Directory Review Report” concludes that too often a directory entry is incorrect because the provider wasn’t at the listed location, the phone number …

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False Claims that Don’t Violate the False Claims Act

The False Claims Act (FCA) establishes heavy liability (treble damages and penalties that can exceed over $20,000 per claim) for any person who knowingly presents a false claim for payment to the government.  It also provides a right of action for any employee fired for trying to stop violations of the act. So …

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Iowa Drug Pricing Disclosure Law Bites the Dust

In 2014 Iowa enacted a statute requiring pharmacy benefit managers (PBMs) to disclose pricing methodologies to their network pharmacies and to the State Insurance Commissioner.  Is the statute “a patchwork of costly mandates on employers and unions,” as the national PBM association argues, or is it an effort …

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Qualifications for Artificial Limb Suppliers, After Only 16 Years

Bill Clinton was President when Congress enacted a law requiring CMS to come up with qualifications for those who make or supply artificial limbs to Medicare patients.  It was January 11, 2017, when CMS finally unveiled the proposed qualifications.  And, having taken over 16 years to produce the proposal, CMS …

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Physician Liability for Death of Nonviable Fetus

If an obstetrician’s negligence causes the miscarriage of a nonviable fetus—i.e., one that couldn’t live outside the womb--does the patient have a cause of action for wrongful death?  In Alabama the answer is yes, according to a unanimous opinion by the state’s highest court. Kimberly Stinnett alleged …

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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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