» Professional Whistleblower Nabs Another Hospital for False Outlier Payments

Professional Whistleblower Nabs Another Hospital for False Outlier Payments

Friday, March 5, 2010

Hospital billing consultant knew exactly how to blow the whistle — and gets $613,000 for his trouble. Brookhaven Memorial Hospital Medical Center in Long Island, NY will pay the federal government $2.92 (excluding interest) to settle…

Internal Auditor Turns Whistleblower at Cardiology Practice

Monday, January 4, 2010

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Upcoding E/M services at heart of the case An internal auditor turned whistleblower when she felt a Michigan cardiology practice was ignoring her concerns about evaluation & management upcoding. A $669,413 settlement with the Department of Justice is the end result.…

Dissected: Health Care Fraud Enforcement Act of 2009

Sunday, November 15, 2009

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Photo: Mary Ann Reitano Bill would make it easier for prosecutors to link kickback violations with false claims. It’s clear that some legislators think that regulators still don’t have the statutory tools…

‘Sub-Standard Care’ the Crux of Medicaid FCA Case

Monday, November 9, 2009

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Therapists formerly employed at a residential treatment center blow the whistle. Many times, False Claims Act cases in health care hinge on the fact that claims were submitted to Medicare or Medicaid when no actual care was provided at all.…

FERA Expands Overpayment Liability with ‘Reverse False Claims’

Monday, November 9, 2009

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Plus, why it’s easier than ever for folks to become whistleblowers. If you don’t know what a reverse false claim is, it’s time to figure it out. With the Fraud Enforcement and Recovery…

COMPLIANCE TRENDS: Covenant Case Holds Stark Reminders for Hospitals, Physicians

Monday, November 2, 2009

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Don’t rely overly on the employment exception — or discount a competitor’s ability to stir up trouble. Covenant Medical Center in Waterloo, Iowa, recently agreed to fork over a hefty $4.5 million to settle a federal False Claims Act lawsuit involving alleged…

FERA: How and Why Congress Linked the FCA and Medicaid

Monday, November 2, 2009

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What do these guys have to do with Medicaid? You'd be surprised. How a qui tam case involving generators for Navy destroyers ended up going all the way to the Supreme Court…

FERA Expands FCA Liability to Subcontractors

Monday, October 26, 2009

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Find out why the feds are looking even harder at HHA & hospice therapy services. As if worrying about compliance with the False Claims Act wasn’t enough: As part of the follow-on to the 2009 stimulus package,…

Whistleblower Watch: New Law Toughens False Claims Act

Tuesday, June 2, 2009

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What looked like a law that cracks down on mortgage and financial fraud packs a punch to health care reimbursement. If you’ve watched the news over the summer, you’re aware that President Obama signed the Federal Enforcement and Recovery Act (FERA) of…

HC Compliance Essentials

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