For the first time in nearly 20 years the Office of Inspector General (OIG) of the Department of Health & Human Services has issued new guidance on the exercise of its authority to exclude health care providers from participating in federal health care programs, including Medicare, Medicaid, and Tri-Care. …
Texas-Size Sentences for Texas-Size Medicare Fraud
April 13, 2016 Leave a Comment
They do things big in Texas. The latest example is the punishments being handed out for a Medicare fraud scheme at Riverside General Hospital in Houston. Let’s start with the fraud scheme. It was Texas-size, too, resulting in a whopping $158 million in false Medicare claims for partial hospitalization …
OK to Exaggerate How Long Patients Need Device
April 12, 2016 Leave a Comment
Today’s riddle: Why would a federal court approve a medical device manufacturer’s practice of persuading physicians to exaggerate the period of time Medicare patients need their devices? The answer is so simple that you’ll be embarrassed that you didn’t get it right away. Whistleblower Jeffrey …
Court Rejects End-Run of Medicare Appeals Rules
April 8, 2016 Leave a Comment
The Indiana Health Department sent a team to the Nightingale home health care and hospice group, in response to complaints. When CMS received the team’s report, it notified Nightingale that its Medicare certification was being terminated. Nightingale filed a federal lawsuit against the Secretary of Health …
A Grossly Negligent Claim Isn’t a False Claim
March 16, 2016 Leave a Comment
You have to feel sorry for whistleblower Darilyn Johnson. The former billing clerk thought she had a sure-fire, double-barrel False Claims Act (FCA) case against the medical clinic that fired her. Barrel one was her basic FCA case. Darilyn could prove that when the allergy clinic filled out its Medicare …
Eighth Circuit Rejects Hospice’s Fifth Amendment Plea
March 11, 2016 Leave a Comment
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 …