Two More Hospitals Qualify for Exception to Exception to Grandfather Exception to Elimination of Whole Hospital Exception to Stark Law Prohibition

The Stark Law generally prohibits physicians from referring Medicare and Medicaid patients to facilities in which they have an ownership interest.  There used to be a “whole hospital exception” excluding entire hospitals (as contrasted to departments or parts of hospitals) from the prohibition. The …

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Another Study Undercuts Physician-Owned Hospital Suspicions

Physician-owned hospitals cherry-pick well-insured patients, disfavor Medicaid and minority patients, and charge more that their nonprofit counterparts, right?  Wrong, says a new study published on September 2 by respected BMJ (formerly, British Medical Journal). The study, “Access, Quality, and Costs at …

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Whistleblower Filed Too Early & Too Late for Share of $322M SCAN Scam Recovery

In a miracle of bad timing, Jim Swoben managed to lose out on a share of the $322 million recovery against SCAN health Plan by being both too early and too late in filing his qui tam action. During his days as a data encounter manager at SCAN, Jim suspected the company had been double-billing Medicare and …

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Hospital Chain Pays Heavy Price for Being Too Clever

Finding that Community Hospital Systems had been “too clever by half” in negotiating a global settlement agreement for seven whistleblower suits, a federal judge ordered the chain to pay the attorneys’ fees of all the whistleblowers—not just the first to file.  That’s on top of the $97 million Community …

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Court Adopts Tough Interpretation of 60-Day Repayment Rule

New York’s Mt. Sinai Hospitals can’t seem to catch a break in its long-running battle with whistleblower Bob Kane.  First, the government joined the case and wanted not just the $1,000,000 in Medicaid overpayments, but an additional $13,000,000.  Why $13,000,000?  Well, $1,000,000 trebled is $3,000,000; the …

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Bill Would Extend CMPs to Federal Grants

The bill known as the “21st Century Cures,” H.R.6, would extend Civil Monetary Penalties (CMPs) to cover false claims and false statements relating to grants, contracts, and other agreements funded by the Department of Health & Human Services (HHS).  Falsehoods relating to clinical trials appear to be a …

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