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 …
Hospital Chain Pays Heavy Price for Being Too Clever
August 12, 2015 Leave a Comment
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 …
Court Adopts Tough Interpretation of 60-Day Repayment Rule
August 4, 2015 Leave a Comment
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 …