Sep 9, 2024 | False Claims Act, Health Care, Health Care Fraud, Medicare and Medicaid
Late last month, the DOJ announced that St. Peter’s Health agreed to pay $10.8M to settle False Claims Act allegations. The settlement resolves claims that the organization submitted inaccurate information to federal healthcare programs, including Medicare and...
Aug 18, 2024 | False Claims Act, Health Care, Health Care Fraud, Medicare and Medicaid
On August 16, 2024, the plaintiff’s law firm Phillips & Cohen announced that health insurance giant Humana agreed to pay $90 Million to settle a qui tam whistleblower lawsuit filed under the federal False Claims Act (FCA). According to the law firm’s...
Jul 1, 2024 | Medicare and Medicaid
Medicare has recently intensified its focus on durable medical equipment (DME) due to concerns about fraud and overpayments. Common schemes of DME fraud include billing for equipment that was never provided, upcoding to more expensive items, or prescribing medically...
Jun 28, 2024 | Commercial Payor Audits, Medicare and Medicaid, Overpayment Appeals
As most healthcare providers know, Medicare, like most payors, operates on a “pay and chase” system; meaning, they pay the vast majority of claims promptly, and then audit and attempt to recoup overpayments later should they discover information that calls the...
Jun 25, 2024 | False Claims Act, Government Investigations, Health Care, Health Care Fraud, Medicare and Medicaid
The False Claims Act, with its threat of treble damages and astronomical per-claim penalties, may not have been designed to punish substandard medical care, but as a recent $15 million FCA settlement demonstrates, the line between substandard medical care and...
Jun 24, 2024 | False Claims Act, Fraud Investigations, Health Care, Health Care Fraud, Medicare and Medicaid
On June 20, the United States Attorney’s Office for the District of Delaware announced that it filed a civil complaint against a pain management provider, the Center for Interventional Pain and Spine (CIPS) and its principal owner, Dr. Chee Woo. The lawsuit against...
