Nov 11, 2024 | Health Care, Medicare and Medicaid
When the Affordable Care Act was passed and signed into law by President Obama in 2010, one of its provisions required Medicare providers and suppliers to report and refund Medicare overpayments within 60 days of “identifying” such an overpayment. Violating this...
Sep 15, 2024 | DOJ, False Claims Act, Fraud Investigations, Health Care, Medicare and Medicaid
Late last week, the Department of Justice announced that Walgreen had agreed to pay over $106 million to resolve allegations that it violated the False Claims Act by billing government health care programs for prescriptions that were never dispensed. According to the...
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...
