Mar 24, 2025 | Administrative Law, Health Care, Medicare and Medicaid, Overpayment Appeals
Because Medicare processes over one billion fee-for-service claims annually, it is impossible for CMS and its contractors to review every claim – or even a substantial percentage of claims – on a pre-payment basis. Accordingly, Medicare has set up various...
Mar 11, 2025 | Cyber Law, Data Breach, Health Care, Health Care Fraud, HIPAA
In the past week, authorities were alerted to four separate data breaches affecting more than 560,000 individuals across various healthcare organizations. The breaches were disclosed by Hillcrest Convalescent Center, Gastroenterology Associates of Central Florida,...
Feb 28, 2025 | False Claims Act, Government Investigations, Health Care, Health Care Fraud
Back in January, we wrote about a district judge in Massachusetts who granted summary judgment in favor of a False Claims Act (FCA) defendant, ruling that the “but for” causation standard should be applied when violations of the Anti-Kickback Statute (AKS)...
Feb 25, 2025 | Health Care, Health Care Fraud, Healthcare Transactions
On February 20, 2025, Gregory Schreck, 50, of Johnson County, Kansas, pleaded guilty to orchestrating an internet-based operation that defrauded Medicare and other federal health care benefit programs of more than $1 billion. Schreck, vice president at healthcare...
Feb 20, 2025 | DMEPOS, Government Investigations, Health Care, Health Care Fraud, Medicare and Medicaid
If you are a DMEPOS supplier and are purchasing opt-in Medicare leads, you should be aware of Medicare’s prohibition against telephone solicitation of beneficiaries. In order to enroll as a Medicare DMEPOS supplier, and as a condition of payment, DMEPOS providers must...
Feb 17, 2025 | Fraud Investigations, Health Care, Health Care Fraud
A federal jury has found a New York doctor guilty of orchestrating a fraudulent scheme that led to the submission of over $24 million in false claims to Medicare. Dr. Alexander Baldonado, 69, of Queens, was convicted for his role in ordering medically unnecessary...
