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fraud

Trial Court Pushes Back on “Fraud with Particularity” Requirement

[01/26/17]

Posted on January 26, 2017 in False Claims Act Defense

Published by: Hall Render

The Federal District Court for the Middle District of Florida appears  to have rejected recent direction from the Eleventh Circuit Court of Appeal to deny a motion to dismiss in a False Claims Act case. In United States ex rel. Napoli et al. v. Premier Hospitalists PL, et al. the whistle-blowers alleged a hospitalist... READ MORE

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OIG Final Rule Significantly Expands Exclusion Authority

[01/19/17]

Posted on January 19, 2017 in Health Law News

Published by: Hall Render

On January 12, 2017, the Department of Health and Human Services Office of Inspector General (“OIG”) published the “Health Care Programs: Fraud and Abuse; Revisions to the Office of Inspector General’s Exclusion Authorities” Final Rule (“Final Rule”) revising and expanding its authority to exclude individuals and entities from participation in federal health care programs.... READ MORE

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Eleventh Circuit: “Worthless Services” Claim Constitutional in Criminal Fraud Case

[06/24/14]

Posted on June 24, 2014 in False Claims Act Defense

Written by: Drew B. Howk

The Eleventh Circuit ruled last week that a conviction for criminal health care fraud against the owner of nursing home facilities was constitutional. The Court held that the government’s “worthless service” theory of fraudulent billing was not unconstitutional. In United States vs. George Houser, the government alleged that the defendant conspired to defraud the... READ MORE

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CMS Extends and Expands Home Health Enrollment Moratoria

[02/11/14]

Posted on February 11, 2014 in Long-Term Care, Home Health & Hospice

Written by: Kendra Conover

Effective January 31, 2014, the Centers for Medicare & Medicaid Services (“CMS”) has issued a temporary moratoria for the enrollment of home health agencies in Fort Lauderdale, Florida; Detroit, Michigan; Dallas, Texas; and Houston, Texas.  CMS also announced it is extending the current enrollment moratoria in Chicago, Illinois and Miami, Florida for another six... READ MORE

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April False Claims Act Update

[04/15/13]

Posted on April 15, 2013 in False Claims Act Defense

Written by: David B. Honig

Introduction Three cases are addressed in a review of the False Claims Act decisions of the past month. The first, US v. Anchor Mortage Corp., is a significant Seventh Circuit case addressing the proper treble damages calculation under the statute. The second, US ex rel. Carter v. Halliburton, considers the application of the Wartimes Suspension... READ MORE

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Two Florida Home Health Agency Owners Plead Guilty to Fraud

[12/21/12]

Posted on December 21, 2012 in Long-Term Care, Home Health & Hospice

Written by: Kendra Conover

On December 19, 2012 the Department of Justice announced the owners and operators of two Miami health care agencies pleaded guilty for their participation in a $48 million home health Medicare fraud scheme.  According to plea documents, the owners conspired with patient recruiters for the purpose of billing the Medicare program for unnecessary home... READ MORE

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Inappropriate and Questionable Billing by Medicare Home Health Agencies

[08/02/12]

Posted on August 2, 2012 in Long-Term Care, Home Health & Hospice

Written by: Selby, Todd J.

Data collected and analyzed by the Office of Inspector General (OIG) since 2010, indicate that home health agencies (HHAs) are predisposed to commit Medicare fraud, waste and abuse. In 2010, Medicare inappropriately paid $5 million for erroneous claims submitted by HHAs. With one in four claims being suspect, the OIG established six (6) criteria... READ MORE

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CMS Releases Final Rule Requiring Providers to Include NPI on Enrollment and Claim Filings

[04/26/12]

Posted on April 26, 2012 in Long-Term Care, Home Health & Hospice

Written by: Bufford, David W.

The Centers for Medicare & Medicaid Services (CMS) just released a final rule requiring all providers of medical or other items or services and suppliers that qualify for a National Provider Identifier (NPI) to include their NPI on all applications to enroll in the Medicare and Medicaid programs and on all claims for payment submitted... READ MORE

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CMS Postpones Two Anti-Fraud Initiatives

[02/06/12]

Posted on February 6, 2012 in Long-Term Care, Home Health & Hospice

Written by: Bufford, David W.

The Centers for Medicare & Medicaid Services (CMS) has pushed back the start of two anti-fraud programs to June due to provider concerns.  Two pilot programs, one that would require prior authorization for scooters and power wheelchairs and one allowing recovery audit contractors (RAC) to review claims prior to payment, were initially slated to begin January 1, 2012.   READ MORE

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