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...
Feb 23, 2024 | False Claims Act, Fraud Investigations, Government Investigations, Health Care, Health Care Fraud, Medicare and Medicaid, White Collar Crime
On February 22, the Department of Justice (DOJ) released its annual False Claims Act (FCA) statistics for Fiscal Year 2023. The DOJ’s press release announced the “highest number of settlements and judgments in history,” at 543 total settlements and judgments....
Dec 30, 2022 | Health Care, Medicare and Medicaid
In 2014, the Centers for Medicare & Medicaid Services (CMS) published its then-long-awaited final rule implementing and interpreting the “60-day” overpayment rule, which was signed into law by President Obama four years prior as part of the Affordable Care Act. ...
