Physicians, medical groups, hospitals, and anyone who bills a government provider like Medicare must follow strict rules when making their claim for payment. Failing to abide by these rules can result in allegations of wrongdoing and lead to an investigation and...
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False Claims
Diagnostic testing facility owners get 3 years imprisonment for healthcare fraud
The Department of Justice (DOJ) recently announced the sentences for two New York diagnostic testing facility owners. New York officials announced the charges against the two, a married couple, for various healthcare fraud crimes including the payment of over $18...
Feds accuse New Jersey dentist of unnecessary work on children
The case began with a disgruntled employee. A former employee of the dentist filed a claim a lawsuit in 2017 stating that the dental practice was in violation of the False Claims Act (FCA). The former employee used this law to sue on behalf of the government, claiming...
What can my facility learn from the recent closure of NJ nursing home?
A nursing and behavioral center located in New Jersey that served residents of New York and New Jersey is set to close in a matter of weeks. The New Jersey Department of Health revoked the facility’s license due to a failure to correct violations. The agency claims...
What happens if the OIG accuses my practice of a Medicare overpayment?
The Social Security Act requires provider's report any Medicare overpayment. A failure to do so can result in more than just a need to pay the government back, it could escalate to criminal charges. But what happens if the government makes a mistake? How do these...
One big lesson after hospital system hit with $4M penalty for FCA violation
One of the largest, private for-profit hospital systems in the nation agreed to pay over $4.5 million to settle allegations that it violated various federal laws, including the False Claims Act (FCA). The healthcare corporation, Steward Health Care System LLC, owns...
Feds continue crackdown on opioids, go after physicians for FCA violations
The government continues its aggressive crackdown on the use of opioids. Although the overall goal of attacking the over prescription and abuse of this highly addictive medication is noble, the reality can mean destructive allegations against physicians throughout the...
Case shows need to review billing dates before submitting claim to Medicaid
Filling out paperwork is often a tedious, time-consuming process. This is true on both sides of the healthcare system — neither patients nor hospitals or physicians are likely to find joy in filling out the paperwork required by insurance providers. But a failure to...
What happens when the feds accuse a pharmacy of an FCA violation?
The feds are aggressive when it comes to pursuing allegations of healthcare fraud. One of their favorite legal tools to use when building these cases is the False Claims Act (FCA). This law basically states that the feds can go after any business that falsely bills a...
DOJ cracks down on a dozen health care fraud cases since Oct. 1
The United States Department of Justice (DOJ) continues to make prosecution of health care fraud a top priority. Since October 1st alone, the feds have pursued over a dozen health care fraud cases throughout the country. Some of the more notable include allegations...