It could be the Mean Girls sequel we have been anxiously awaiting: a Napa Valley surgeon alleges that his colleagues and area hospitals ruined his reputation and eliminated his practice in violation of federal antitrust laws. A California federal district court ruled that his case was plausible enough to …
Aetna Wins $37.5 Million for Overbilling Scheme
April 18, 2016 Leave a Comment
It’s easy to fall into the habit of regarding self-referrals and kickbacks as strictly a matter of federal law, governed only by the federal Stark Law and Anti-Kickback Statute. But an April 13 verdict in California provides a vivid reminder that state law also has a role and that private insurers can be as …
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 …
What’s In a Name? Not Much, Says Colo. Federal Court
April 6, 2016 Leave a Comment
On March 31 a federal court in Colorado threw out a suit by 80 chiropractors against several national health insurers. The chiropractors alleged that the insurers violated Colorado law by paying them less than physicians and other health care professionals for the same services. As the judge saw it, the …
FTC Wants to be a Champion for Telemedicine Providers
March 30, 2016 Leave a Comment
In a public comment supporting Alaska’s proposed telemedicine legislation, the Federal Trade Commission (FTC or Commission) reiterated its broad support for telemedicine services, quoting its own 2004 analysis: “When used properly, telemedicine has considerable promise as a mechanism to broaden access, lower …
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 …