New attorney general, Justice policies could take steam out of False Claims Act cases
A new attorney general at the helm, plus possible policy changes on the horizon, could spell a slowdown in fraud accusations against providers.
A new attorney general at the helm, plus possible policy changes on the horizon, could spell a slowdown in fraud accusations against providers.
Nursing home chain Preferred Care agreed to settle False Claims Act charges for $540,000, the Department of Justice has announced.
A for-profit hospice company and its owner agreed to pay $1.2 million to resolve allegations that the company fraudulently billed Medicare and Medicaid for hospice services.
A federal judge erased a $347 million False Claims Act verdict against a rehab provider because the judge felt it was unlikely that government would have withheld payments even if it was aware of billing violations.
A federal judge in Florida has tossed a $347 million False Claims Act verdict against a nursing home operator, saying there wasn’t evidence the government would have withheld payment if aware of the billing violations later brought by a whistleblower.
The nation’s largest for-profit hospice provider and its parent company have agreed to pay $75 million to settle allegations that it submitted false Medicare claims for hospice services, authorities said Monday.
A Florida-based provider has breathing room to appeal a $347 million judgment after a federal judge said the payment could force 183 facilities to collapse.
Not surprisingly, different federal courts have staked out different positions on the standard for liability under a worthless services complaint.
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.