Far-Fetched Whistleblower Claim of the Month

The hospital industry is accustomed to far-fetched whistleblower claims: allegations that a hospital knowingly submitted false or fraudulent Medicare or Medicaid claims or fired a whistleblower for trying to prevent such activity.  But in terms of far-fetched claims decided in January, whistleblower Jana Endicott …

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Another Challenge to U.S. on Risk Corridor Payments

Molina Healthcare has joined the long line of insurers suing the government for failure to honor its obligations under the Affordable Care Act’s “risk corridor” program.  According to Molina’s 84-page complaint filed Jan. 23, the U.S. owes it a whopping $52.3 million. Enacted in 2010, the Affordable …

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Agency Law Takes Center Stage in Psychologist Torture Case

If you think agency law is boring, take a look at the Jan. 27 opinion by a federal court in the torture case brought by three foreign citizens against two psychologists who worked for the CIA.  The plaintiffs filed suit under the Alien Torture Act, alleging that they were subjected to an experimental torture …

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Hospital Insists it Was Malpractice; Patient Disagrees

At first glance it looks like a “Man Bites Dog” headline.  The hospital insists that the patient was injured by professional negligence; the patient vehemently disagrees.  The argument goes all the way to the state court of appeals. The explanation is immediately clear to medical malpractice lawyers: the …

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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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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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