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Presented by Hodgson Russ, the Whistleblower Blog is written by a team of lawyers experienced in successfully guiding both whistleblowers and companies accused by whistleblowers of wrongdoing through the False Claims Act process.
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Showing 25 posts in Medicare & Medicaid Fraud.
Important Laws to Trigger False Claims Act Liability
False Claims Act liability has been based on defendants falsely certifying their compliance with laws and regulations. But in deciding which laws and regulations can be used as a basis of this type of liability, such that defendants deserve the huge fines and penalties of the False Claims Act, courts often have to make subjective decisions about what laws and regulations are “important” enough for this type of liability.
To take a recent example, in United States ex rel. Wilkins v. United Health Group, Inc., the U.S. Court of Appeals for the Third Circuit had to decide which laws and regulations among the hundreds of thousands imposed on Medicare participants were sufficiently seriously to merit False Claims Act liability through their violation.
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Teleradiology Ghost Reading Present False Claims Act Issues
Teleradiology is becoming more and more common. This technology involves transmitting images, such as x-rays, CT scans, MRIs, and ultrasounds, over the Internet to a radiologist at another location to read and interpret. In many cases, this allows radiologists to work from home or other remote locations. And in some cases, radiologists in non-local time zones can help out on urgent issues that develop overnight in distant locations.
So far so good. But what if the radiologist is in another country? In fact, radiology reads have been outsourced to many locations around the world in recent years. India, Australia, Brazil, Switzerland, and Israel are common sources. Many have referred to this practice as “nighthawk” teleradiology.
Fraud-Fighting Report Request From Health and Human Services
On March 24, Senate Finance Committee leaders Orrin Hatch and Max Baucus sent a letter to the Department of Health and Human Services (HHS) Office of the Inspector General (OIG) and the Centers for Medicare & Medicaid Services (CMS) deputy administrator requesting data, benchmarks, and updates on the number of fraud cases and the amount of money recovered. The letter requested quarterly reports on how resources allocated for fighting waste, fraud, and abuse are being used and on the results. These reports are sought to better use additional resources to support fraud-fighting efforts in an HHS-based complement to False Claims Act enforcement.
Health Care Fraud Prevention | CareSource Settlement
The Department of Justice recently intervened in and settled a False Claims Act case filed by two nurses against their employer, CareSource, an Ohio managed health care company. The settlement resolves allegations that the company caused Medicaid to make payments for assessments and case managements they failed to provide. According to the government’s February 1 press release, as part of the settlement, the whistleblower employees will receive a $3 million share of the federal portion of the $26 million settlement.
Medical Industry Whistleblower Settlements Increase
False Claims Act settlements are increasing dramatically in the medical industry, and many of the growing number of settlements are being paid by an unlikely target: hospitals. Over the past few months, Brookhaven Memorial Hospital Medical Center, in Long Island; Mercy Hospital, in Springfield, Massachusetts; and Southern New Hampshire Medical Center, in Nashua, New Hampshire, all resolved False Claims Act cases with considerable settlements. Most of the whistleblower claims were based on allegations of improper charges to obtain Medicare and Medicaid reimbursement. Read more here.
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