False Claims Act
Recent FCA complaints have relied on a number of arguments to substantiate the submission of false claims for Medicare reimbursement: systematic upcoding to higher RUG levels due to corporate "pressure" on front line care providers; targeting therapy at or around RUG thresholds; increasing therapy during "look back" periods; and providing skilled therapy that was not required for improvement in functioning.
Long-term care providers would do well to know the lesson from one Pennsylvania continuing care facility, which averted costly litigation when it discovered and later reported irregularities of more than $1 million in Medicare claims.
A federal judge has dismissed a former Brookdale Senior Living employee's False Claims Act suit against the company while leaving the door open for an amended complaint, according to published reports
A complex argument over how to identify Medicaid overpayments could be why the Centers for Medicare & Medicaid Services postponed its pending rule on waiting periods for overpayment resolution, a Washington, DC, lawyer said Thursday.
The former chair of a National Quality Forum safety committee has agreed to pay a $1 million civil fine to settle allegations he violated the False Claims Act by soliciting and accepting kickbacks, according to the U.S. Department of Justice.
A federal judge has ruled that a hospitalist company with thousands of post-acute care customers must face federal charges that it overbilled the Medicare and Medicaid programs millions of dollars.
A New York hospice provider Wednesday agreed to pay approximately $6.5 million in fines to settle alleged false Medicare and Medicaid claims over a 16-month period.
Hospice company settles False Claims Act allegations for $4 million ... Colorado says no to right-to-die legislation ... NYT examines Obamacare's issue for GOP ... PA recovers $1.8 million for long-term care funds
NJ physicians to face charges that they kept people as inpatients to qualify them for SNF coverage, judge rulesSeptember 03, 2014
A whistleblower can continue to pursue charges that a number of New Jersey physicians improperly designated Medicare beneficiaries as inpatients and sometimes prolonged their hospital stay to qualify them for skilled nursing care, a federal judge recently ruled.
An Illinois nursing home won a victory last week when the U.S. Court of Appeals for the Seventh Circuit voided a $9 million verdict.
A panel of witnesses debated the merits of the False Claims Act before a Judiciary subcommittee meeting Wednesday, with one former attorney general arguing current policy provokes unfair litigation and "coercive" settlements.
Nursing home cannot use Medicaid payment structure to evade 'worthless services' charges, federal court rulesJuly 17, 2014
A nursing home cannot cite Medicare and Medicaid payment methods to escape charges that it provided "worthless services," a federal judge recently ruled in a False Claims Act case.
Fraud prevention system doubled its improper Medicare payment collections ... Healthcare groups ask Supreme Court to declare False Claims Act penalty system unconstitutional ... New LTC administrator code of ethics updates discrimination and personal conduct language ... IA nursing home agrees to $500,000 settlement over improper therapy claims
A hospitalist company that works with thousands of post-acute care facilities is officially facing federal charges that its clinicians routinely overbilled Medicare and Medicaid, authorities announced Tuesday.
Charges that Omnicare disguised nursing home kickbacks as charitable contributions can proceed, federal judge rulesApril 22, 2014
A whistleblower can keep pursuing his allegations that long-term care pharmacy Omnicare funneled payments to nursing home owners through so-called charitable donations, U.S. District Court Judge Robert M. Dow Jr. recently ruled. Dow dismissed other charges leveled in the suit.
A whistleblower exposed disturbing drug packaging practices being used by long-term care pharmacy Omnicare Inc., but the charges don't fall under the False Claims Act, a federal appeals court recently ruled.
An optometrist who served Georgia nursing homes faces a 33-month prison sentence for defrauding Medicare.
The federal government has intervened in a whistleblower lawsuit alleging that a large hospitalist company systematically overbilled government health programs, the U.S. Department of Justice announced Monday.
Omnicare, the nation's largest provider of long-term care pharmacy services, has agreed to pay $120 million to settle a False Claims Act lawsuit over Medicare Part A drug pricing, the company announced Wednesday. The settlement likely is one of the largest in a whistleblower case in which the government did not intervene, according to Frederick Morgan, one of Gale's attorneys at the firm Morgan Verkamp LLC.
Brookdale Senior Living has sued PharMerica, charging that the long-term care pharmacy improperly changed its drug pricing for Brookdale facilities.
PharMerica has been charged in a False Claims Act lawsuit by the federal government.
Long-term care pharmacy company PharMerica dispensed controlled narcotics without valid prescriptions and billed Medicare for the drugs, the federal government has charged in a False Claims Act lawsuit.
A whistleblower who alleges Omnicare Inc. paid kickbacks to nursing homes did not violate the False Claims Act, a judge has ruled.
Judge denies Omnicare's 'untimely' motion to disqualify whistleblower in nursing home kickbacks caseJune 19, 2013
Omnicare has failed to disqualify a whistleblower who alleges the long-term care pharmacy paid kickbacks to nursing homes, ruled a district court judge.
Comments on a public conference call led to whistleblower lawsuit against nursing home therapy providerMay 28, 2013
Comments made during a therapy provider's public conference call in 2006 aroused the suspicion of a listener, who went on to file a whistleblower lawsuit. This was disclosed in a recent court filing in the case, which pits the whistleblower and the U.S. government against RehabCare, the provider that hosted the 2006 call.
Long-term care pharmacy Omnicare will not face charges that it engaged in "nationwide" Medicare fraud for off-label antipsychotics prescriptions, a federal judge recently ruled. However, the pharmacy still faces more limited False Claims Act charges over billing for antipsychotic drugs allegedly used for dementia care.
A government lawsuit and a memorandum from the Department of Health and Human Services Office of Inspector General raise questions about the two most expensive types of hospice care.
A whistleblower lawsuit involving a nursing home chain and therapy providers in Missouri can move forward, a federal judge has ruled. The False Claims Act case originated with allegations that a therapy company received more than $10 million in kickbacks as part of a scheme to overbill Medicare and Medicaid.
A provision of the Affordable Care Act on kickbacks could ensnare innocent providers, panelists said at a recent American Health Lawyers Association conference.
Here's the good news for providers: new analytics are making it possible to understand and bill your care in ways that would have been impossible just a few years ago. Here's the bad news: The government is quite aware of these new options.