If a hospital’s extortion and wire fraud activity is brief enough, it can avoid RICO prosecution. That’s one lesson in an October 2 decision by the federal court for the district of Idaho. Danielle Bennion and her co-plaintiffs filed a RICO (Racketeer Influenced & Corrupt Practices Act) action …
August Scam-of-the-Month Award
August 21, 2014 Leave a Comment
The month is only two-thirds over, but it’s already clear who wins the August Scam-of-the-Month Award. Cleveland Imaging & Surgical Hospital, in Cleveland, Texas, wins in a walk. It turns out that back in 2011 the hospital sold the right to use its hospital billing codes to free-standing clinics. So …
Unnecessary Surgeries Put Hospital in Three-Front War
August 14, 2014 Leave a Comment
When the government accuses a hospital of committing Medicare fraud by billing for unnecessary surgeries, the hospital has a real problem on its hands. It’s at war with the government, and that’s expensive, as well as nerve-wracking. But unless that battle ends in anything short of a complete victory for …
ANOTHER CMS WEAPON: SENIOR SLEUTH SQUAD
June 18, 2014 Leave a Comment
She’s seventyish, grandmotherly and unassuming. She sits patiently in the waiting area of your hospital or medical office, knitting to while away the time. She couldn’t be any less threatening, right? Wrong. She could be part of yet another weapon in the CMS arsenal: the Senior Medicare Patrol. The …
KENTUCKY HOSPITAL PAYS $41 MILLION TO SETTLE FRAUD CHARGES
May 30, 2014 Leave a Comment
Yesterday Kentucky’s largest hospital, King’s Daughters Medical Center, in Ashland, announced its agreement to pay $40.9 million to settle charges that it committed Medicare and Medicaid fraud by billing for coronary procedures that were unnecessary and by falsifying medical records related to those …
PHYSICIAN WHO DEFRAUDED AUTO INSURER ISN’T ENTITLED TO ARBITRATION
May 7, 2014 Leave a Comment
Over a four-year period Dr. Mun billed Allstate $500,000 for supposed “electrodiagnostic testing” of auto accident victims. Allstate paid the claims as they came in. About ten months after the last of the alleged tests, Allstate sued the doctor in federal court, alleging that the billing was fraudulent and …