The hospital industry is accustomed to far-fetched whistleblower claims: allegations that a hospital knowingly submitted false or fraudulent Medicare or Medicaid claims or fired a whistleblower for trying to prevent such activity. But in terms of far-fetched claims decided in January, whistleblower Jana Endicott …
Medicare Appeal Proposal Falls Far Short of Court Mandate
January 25, 2017 Leave a Comment
For years the hospital industry has been in an uproar over the mountainous backlog of Medicare claim appeals. Current estimates are that a whopping 650,000 claims are at the Administrative Law Judge level awaiting adjudication. Worse yet, the backlog has been growing at a dizzying rate, with requests for ALJ …
2016 Nerve-of-a-Burglar Award
January 10, 2017 Leave a Comment
Competition for the 2016 Nerve-of-a-Burglar Award was fierce, with health care providers constantly coming up with new and different ways to scam Medicare and Medicaid. Nevertheless, we have a clear winner: the Michigan physician charged with an array of fraudulent Medicaid schemes that included ordering …
Another Blow to Medicare “Self-Disallowance” Rule
August 25, 2016 Leave a Comment
You can tell by its name that you won’t like the Medicare “self-disallowance” rule. The federal district court for D.C. didn’t like it, either, and gave a group of Banner Health hospitals summary judgment that the rule was invalid as applied to the group’s appeal. Medicare pays hospitals under the …
The Law Doesn’t Forbid Submitting False Claims
August 24, 2016 Leave a Comment
An Eighth Circuit decision provides a reminder that the False Claims Act doesn’t forbid submitting false claims: it forbids knowingly submitting false claims. That made all the difference in an appeal of summary judgment in favor of a physician group that, according to the relator, failed to comply with …
What’s In a Name? Or, the Importance of Emphasis
August 17, 2016 Leave a Comment
I.A. Khair of New Jersey ran an ambulance company called K&S Invalid Coach. Presumably, “Invalid” was pronounced IN-va-lid, with the emphasis on the first syllable. Maybe it should have been pronounced in-VAL-id, with the emphasis on the second syllable. Why? Because by running the company Khair …