Difference of Medical Opinions Doesn’t Prove One Was False

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 …

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Posting Chargemasters On-Line: Less than Meets the Eye

Michigan is just the latest state to consider legislation requiring hospitals to post their chargemasters on-line.  Mich. Sen. Bill 147.  These proposals have been popping up since 2013, when Time magazine devoted a full issue to the evils of hospital pricing and identified the chargemaster as the main …

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Eighth Circuit Rejects Hospice’s Fifth Amendment Plea

But not the Fifth Amendment plea you’re thinking of.  It was the takings clause, not the self-incrimination clause, that Southeast Arkansas Hospice (SAH) was pleading.  And the Eighth Circuit wasn’t buying it. Medicare caps the annual reimbursement a hospice may receive.  The program requires repayment …

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Masked Man Robs Government; Faces 10 Years

The mask itself didn’t raise any suspicions.  After all, the man wearing it—Richard Toussaint--was an anesthesiologist.  But like so many other masked men, he turned out to be a thief.  That’s why on March 4 he was convicted in a Texas federal court on seven counts of health care fraud totaling about $10 …

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GAO Report Says Hospital-Physician Consolidation Requires Payment Reform

Yesterday the Government Accountability Office (GAO) requested that Congress order Health & Human Services to equalize Medicare payments for the same services, whether provided in a physician office or in a hospital outpatient department (HOPD). The report focuses on the ever-increasing consolidation of …

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Words Hurt: FTC Challenges Proposed Hospital Merger Using Parties’ Own Statements

The Federal Trade Commission (FTC or Commission) authorized action on November 6 to block the proposed merger of two hospitals located in Huntington, West Virginia. The FTC issued an administrative complaint alleging that the transaction would create a near monopoly for general acute care inpatient hospital …

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