Labs Settle With UnitedHealthcare For $56.2 Million

UnitedHealthcare Insurance Co. has agreed to settle a lawsuit it filed in 2016 against five toxicology laboratory companies for $56.2 million. The suit, filed in U.S. District Court for the Southern District of Florida, alleged that medical testing lab executives offered kickbacks in the form of partnership shares to treatment facilities and doctors in exchange […]

Report: Many High-Risk Medicaid Providers Not Undergoing Critical Background Checks

Eighteen states failed to properly screen high-risk providers before allowing them to receive Medicaid payments by the July 2018 deadline and 13 of those states had not yet complied by Jan. 1, 2019. Those are the findings from a recently released report by the U.S. Department of Health and Human Services Office of Inspector General. […]

Growth of Telemedicine Sees Increase in Healthcare Fraud

Earlier this month, a New York anesthesiologist was indicted on charges stemming from her role in an alleged telemedicine conspiracy to submit fraudulent claims to federal and private insurance plans. The indictment alleges that Anna Steiner, also known as Hanna Wasielewska, along with others, ordered and prescribed durable medical equipment (DME) and prescription drugs in […]

OIG Takes Notice as Compound Drug Use Skyrockets

The cost of compounded topical drugs to the country’s Medicare program has skyrocketed over the past several years, and that’s gotten the attention of a government watchdog agency. In a recently released report, The U.S. Department of Health and Human Services Office of Inspector General (OIG) found that Medicare Part D spending for these drugs […]

CMS Proposes Payment Changes for Medicare HHAs for 2019

The Centers for Medicare & Medicaid Services (CMS) is soliciting comments on a proposed rule that will impact payment and policy for home health agencies and home infusion therapy suppliers. The proposed rule is an update to the Medicare home health prospective payment system rates for calendar year 2019, as well as a broader case-mix […]

CMS Proposes Sweeping Changes to Restore Doctor-Patient Relationship

Talk to any healthcare provider and one of the things you likely will hear is that they spend too much time on paperwork and not enough time with patients. The Centers for Medicare & Medicaid Services (CMS) says it wants to change that. Earlier this month, the agency that administers the Medicare program proposed what […]

Common Healthcare Fraud Schemes

Last month’s indictment of more than 600 people nationwide in what the feds dubbed “the largest healthcare fraud takedown in history,” should serve as a warning that the government is serious about cracking down on those who abuse the system. As we wrote about in June, of the 601 defendants charged, 165 were medical professionals […]

Failure to Repay Can Result in FCA Case

There’s nothing wrong with holding on to money for as long as you can before giving it back, is there? Well, if you’re a medical practice and you delay repaying overpayments owed to the government, then it can get you in some hot water. That’s what happened to First Coast Cardiovascular Institute, P.A., a Jacksonville, […]

The FCA and the Use of Statistical Sampling

The U.S. Department of Justice late last month agreed to a $275,000 settlement in a False Claims Act case against a South Carolina-based company that operates elder care facilities. What’s significant about this case is that two years earlier, the DOJ rejected a significantly higher – $2.5 million – settlement. In the initial case, United […]

Feds File False Claims Act Lawsuit Against UnitedHealth Group

Is it the government’s “murky policies,” as suggested by a UnitedHealth spokesman, or was it outright fraud that led to allegations the healthcare insurance giant engaged in fraud? That’s a question that will have to be answered following the U.S. Department of Justice’s recent decision to intervene and file a complaint against UnitedHealth Group (UHG). […]

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