They do things big in Texas. The latest example is the punishments being handed out for a Medicare fraud scheme at Riverside General Hospital in Houston. Let’s start with the fraud scheme. It was Texas-size, too, resulting in a whopping $158 million in false Medicare claims for partial hospitalization …
OK to Exaggerate How Long Patients Need Device
April 12, 2016 Leave a Comment
Today’s riddle: Why would a federal court approve a medical device manufacturer’s practice of persuading physicians to exaggerate the period of time Medicare patients need their devices? The answer is so simple that you’ll be embarrassed that you didn’t get it right away. Whistleblower Jeffrey …
Difference of Medical Opinions Doesn’t Prove One Was False
April 4, 2016 Leave a Comment
A federal court in Alabama dealt a blow to the theory that in matters of medical judgment, a false claim action can rest on expert opinion evidence alone. A patient is eligible for hospice if the prognosis is life expectancy of six months or less, assuming the terminal illness runs its course. The government …
Retaliation Claim Survives Though False Claim Act Claim Is False
March 28, 2016 Leave a Comment
Roxanne Perkins was employed as a clinical supervisor of prior authorizations therapy at Wellcare Health Plans. When she returned from a leave of absence, she learned that Wellcare had instituted a new practice of approving all preauthorization requests for durable medical equipment. She complained that the …
Most Imaginative Whistleblower Claim of the Month
March 18, 2016 Leave a Comment
Vicki Sheldon is the hands-down favorite to claim this month’s Most Imaginative Whistleblower Claim award. Vicki’s at-the-time husband Duane was employed at Kettering Health Network (KHN). Duane had an affair with another KHN employee, and the two of them impermissibly accessed Vicki’s medical records. …