Fraudulent billing continues to be a major issue throughout the healthcare industry. We have discussed various cases and settlements over time. A topic within this realm that seems to grow in importance is the risk adjustment fraud that occurs concerning the...
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Healthcare Fraud
Doctor charged by the state for unnecessary tests
Attorney General Letitia James announced on August 1 that a medical doctor from Kings Point and his company (America’s Imaging Center, Inc.) are accused of unnecessary radiological testing and kickbacks to employees and defrauding Medicaid. The years-long scheme...
Can the Feds have a qui tam case dismissed?
On June 21, 2022, the U.S. Supreme Court agreed to hear a case that hinges on whether the federal government can drop cases taken up on its behalf as a qui tam action. The dispute involves whether the government can drop the case regardless of whether the relator or...
Two charged by DOJ in $1.4 billion health care fraud scheme
The Middle District of Florida convicted two men of a $1.4 billion health care fraud after a 24-day trial. They conspired to fraudulently bill private insurers using a sophisticated pass-through billing system where drug test analyses were reportedly conducted in...
Hospitals face penalties for not making prices public
The Centers for Medicare and Medicaid Services (CMS) hit two hospitals in Georgia with $1.1 million in financial penalties for violating the 2021 rules requiring hospitals to share their medical procedures and treatment prices. This change (which the CMS will enforce)...
Feds bring suit against two company heads running 11 nursing facilities
The Southern District of New York and the U.S. Department of Health and Human Services have filed a healthcare lawsuit against 11 New York-based defendants. The lawsuit seeks damages and penalties for billing Medicare for unreasonable or unnecessary procedures at 11...
Home healthcare agencies settle claims of not appropriately paying staff
Two licensed home care services agencies in Brooklyn have settled claims of not appropriately paying their staff. The cases were heard in the Eastern District of New York. All American Homecare Agency and Crown of Life violated the federal False Claims Act and New...
Three healthcare fraud trends two watch for 2022
The pandemic stretched the health care system beyond its limits, causing waiting rooms to overflow with those trying to get treatment and hospital beds to be hard to come by. While things have settled down in the spring of 2022, the aftermath of the last few years...
Whistleblowers help DOJ recover billions
The Department of Justice recovered over $1.6 billion thanks to qui tam whistleblower lawsuits in the fiscal year 2021, which is October 1, 2020, to September 30, 2021. The qui tam provisions under the False Claim Act empower private citizens to file lawsuits on...
DOJ takes first case involving data mining
In September of 2021, the Justice Department accused a health insurer in upstate New York and an affiliated medical data analytics company of cheating the federal government out of tens of millions of dollars. The civil complaint of fraud is the first to target a data...