The False Claims Act (FCA) allows others to initiate a claim on behalf of the government. If the claim moves forward, the government may choose to join. If it leads to a settlement or award, the individual who initiated the case gets a portion of the award. As a...
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Health & Health Care Law
Three tips for pharmacy owners looking to sell in ‘21
Those who have built not just a profession as a pharmacist, the business of the pharmacy as well will likely treat retirement differently compared to pharmacists who have chosen to work for a hospital or retail chain. Those who own their own pharmacy must also look to...
Feds question NY hospitals for giving board members vaccines
The COVID-19 vaccine is making its way throughout the community, but who gets the vaccine first? The answer to this question is not always clear and some hospital systems are finding themselves publicly chastised for failing to go in what others may view as the...
What happens if CMS notifies my group of a Medicare overpayment?
The United States Centers for Medicare and Medicaid Services (CMS) defines a Medicare overpayment as one that exceeds a regulation and statute properly payment amount. Additional issues arise if the feds can establish that the provider was aware of the overpayment....
Jury finds opioid executives guilty
The government has been very clear on its take on the current opioid crisis. It is coming down on medical professionals that do not follow regulations when prescribing these medications and pushing for serious penalties. In one recent case, the government was able to...
Three examples of False Claims Act Violations in 2017
The government collected over $1.8 billion in Medicare and Medicaid fraud cases in 2017. The government collected these funds through a combination of criminal convictions and settlements. Medicare fraud settlements with the government accounted for over $27 million....
Should criminal allegations lead to loss of hospital privileges?
A pediatric surgeon facing allegations of cybersnooping on his now ex-girlfriend is in the midst a national debate over when a physician should lose his or her hospital privileges. Should the hospital consider a physician accused of a crime innocent until proven...
New York psychiatric center blamed for death of child
A 14-year-old patient at a New York psychiatric center suffered cardiac arrest due to a severe case of constipation and bowel obstruction. The center transferred the girl to a university hospital. She died within 24-hours of the transfer. The psychiatric center...
1157 convicted for Medicaid fraud related offenses in 2017
The Office of the Inspector General (OIG) recently reported that the Medicaid fraud control units (MFCUs) secured 1157 fraud convictions. The MFCU investigates those accused of Medicaid fraud. What leads to an investigation by an MFCU? The investigations are generally...
How will you know if you have a Medicare overpayment?
Due to a variety of circumstances, such as clerical errors, duplicate payments or processing mistakes, recipients of Medicare can receive too much money. The Centers for Medicare & Medicaid Services requires recipients to return any excess funds within 60 days, or...