On February 11, 2016, CMS released the much anticipated final rule on the so-called “60-day rule.” The long road to the final rule began when the Affordable Care Act (ACA) established the 60-day deadline for returning Medicare and Medicaid overpayments. The clock started running from the time an overpayment …
Criminal Conviction Leaves Defendant Defenseless in FCA Civil Action
February 2, 2016 Leave a Comment
Pity Dr. Christina Clardy. In 2011 she was convicted of health care fraud, sentenced to 135 months in prison, and ordered to pay $16 million in restitution. Then in 2014 the government added Christina as a defendant in its pending False Claims Act (FCA) civil action against her cronies in the physical …
Suing the Hand that Feeds You
October 6, 2015 Leave a Comment
Jeffrey Jacobs alleges that Idaho’s Pocatello Hospital violated the False Claims Act because of physician recruitment contracts that were overly generous to his practice group. Jeff should know because he was recruited under one of the contracts and worked for the group for three years. According to the …
Two More Hospitals Qualify for Exception to Exception to Grandfather Exception to Elimination of Whole Hospital Exception to Stark Law Prohibition
September 17, 2015 Leave a Comment
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 …
Another Study Undercuts Physician-Owned Hospital Suspicions
September 4, 2015 Leave a Comment
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 …
Whistleblower Filed Too Early & Too Late for Share of $322M SCAN Scam Recovery
September 2, 2015 1 Comment
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 …