False Claims Act

 'Extrapolation' demonstrates False Claims Act liability in rehab

'Extrapolation' demonstrates False Claims Act liability in rehab

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.

Self-reporting False Claims Act violation averts litigation

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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.

Brookdale 'whistleblower' suit dismissed

Brookdale 'whistleblower' suit dismissed

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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

False Claims Act suit could affect CMS overpayment rule

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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.

Former NQF safety advocate settles false claims complaint for $1 million

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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.

Court: Provider must face federal upcoding charges

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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.

Hospice pays $6.5 million fine to settle fraud case

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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.

Also in the news for Tuesday, February 10

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 rules

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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.

$9 million verdict against nursing home thrown out by appeals court

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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.

Revisions to False Claims Act urged by former deputy AG

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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 rules

Nursing home cannot use Medicaid payment structure to evade 'worthless services' charges, federal court rules

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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.

Also in the news for June 26, 2014 . . .

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

Hospitalist company with long-term care presence faces federal charges of upcoding

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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 rules

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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.

Court expresses concern over Omnicare drug packaging practices but dismisses False Claims suit

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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.

Nursing home optometrist gets 33-month sentence for overbilling

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An optometrist who served Georgia nursing homes faces a 33-month prison sentence for defrauding Medicare.

Federal government joins upcoding case against hospitalist company operating in LTC facilities

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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 reaches $120 million settlement in whistleblower suit over SNF drug prices

Omnicare reaches $120 million settlement in whistleblower suit over SNF drug prices

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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 sues PharMerica over drug prices

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Brookdale Senior Living has sued PharMerica, charging that the long-term care pharmacy improperly changed its drug pricing for Brookdale facilities.

PharMerica faces False Claims lawsuit

PharMerica has been charged in a False Claims Act lawsuit by the federal government.

Government whistleblower lawsuit: PharMerica improperly dispensed, billed for narcotics

Government whistleblower lawsuit: PharMerica improperly dispensed, billed for narcotics

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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.

Judge allows whistleblower FCA case against Omnicare

Judge allows whistleblower FCA case against Omnicare

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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 case

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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 provider

Comments on a public conference call led to whistleblower lawsuit against nursing home therapy provider

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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.

Judge dismisses claims of 'nationwide' Medicare fraud in Omnicare antipsychotics case

Judge dismisses claims of 'nationwide' Medicare fraud in Omnicare antipsychotics case

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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.

False Claims lawsuit, government report raise questions about expensive types of hospice care

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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.

Judge lets kickback case vs. therapy provider go forward

Judge lets kickback case vs. therapy provider go forward

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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.

Anti-kickback provision could penalize innocent Medicare providers, attorneys say

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A provision of the Affordable Care Act on kickbacks could ensnare innocent providers, panelists said at a recent American Health Lawyers Association conference.

Shamelessly invoice at your own risk

Shamelessly invoice at your own risk

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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.

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