Legal Insights & Articles

What are Medically Unnecessary Services?

By Susan Schneider Thomas Medical necessity has implications for good, safe patient care and for reimbursement or payment decisions. Although an unnecessary treatment is not always dangerous, it could be used in place of a more appropriate treatment. It could also have side effects or risks that are not justified when the treatment is [...]

By | 2018-12-17T12:23:14+00:00 December 17th, 2018|Healthcare Fraud|

What is the Florida Private Sector Whistleblower Act?

By Susan Schneider Thomas Like many states, Florida generally has an “at-will” employment policy, meaning that employees can be fired at any time for any reason that doesn’t violate a statutory or constitutional protection. For whistleblowers, that statutory protection comes from the Florida Whistleblower’s Act, which protects public employees, or the Florida Private Sector [...]

By | 2018-10-17T14:52:00+00:00 October 17th, 2018|False Claims Act Information|

Tennessee Medicaid False Claims Act

(Tenn. Code Ann. §§ 71-5-181 to 185) By Russell Paul The Tennessee Medicaid False Claims Act (“Tennessee Medicaid FCA”) allows whistleblowers to sue in the name of the State of Tennessee where a wrongdoer engages in conduct that defrauds the state or local government of its healthcare dollars. This statute is designed to address Medicaid fraud. The Tennessee Medicaid FCA [...]

By | 2018-10-10T10:42:04+00:00 October 10th, 2018|False Claims Act Information|

The Pros and Cons of Whistleblowing

By Susan Schneider Thomas If you observe actions that you believe are illegal and cheating the government what should you do? What are the pros or cons of deciding to report that misconduct to someone – possibly someone within your company, who could fix things? Or reporting to a regulatory agency that your business [...]

By | 2018-09-26T11:15:22+00:00 September 26th, 2018|False Claims Act Information|

New Hampshire False Claims Act

By Russell Paul The New Hampshire False Claims Act (“New Hampshire FCA”) was first enacted in 2004. It authorizes whistleblowers with knowledge of fraudulent efforts by persons or businesses to obtain New Hampshire state funds or to avoid an obligation to pay New Hampshire state funds to file suit on behalf of the state [...]

By | 2018-09-25T13:34:12+00:00 September 24th, 2018|False Claims Act Information|

Common Types of Pharmaceutical Fraud

By Daniel Miller Pharmacy fraud can take many forms, some of which can be very costly to taxpayers when the pharmaceuticals involved are paid for by government-funded health programs like Medicare or Medicaid. Some of the most common types of pharmacy fraud include: auto-refilling fraud, off-label marketing of drugs, average manufacturer price/best price fraud, [...]

By | 2018-09-20T17:13:02+00:00 September 20th, 2018|Healthcare Fraud|

The Michigan Whistleblowers’ Protection Act

By Daniel Miller The Michigan Whistleblowers’ Protection Act (“WPA”), Mich. Comp. Laws § 15.361-369 (2017), was enacted in 1980. The WPA protects employees, or agents acting on behalf of an employee, who report or are about to report violations of state, local, or federal law to any public body, from retaliation by their employers, [...]

By | 2018-09-05T11:11:19+00:00 September 5th, 2018|False Claims Act Information|

What are Anti-Kickback Safe Harbors?

By Daniel Miller The federal Anti-Kickback Statute (“AKS”) imposes penalties on anyone who, knowingly or willfully, offers, pays, solicits, or accepts remuneration in exchange for referrals or payments for goods or services reimbursable under a federal health care program.[i] Congress enacted the AKS in 1972, and its primary purpose is “to protect patients and [...]

By | 2018-08-31T11:47:39+00:00 August 31st, 2018|Healthcare Fraud|

How to Report Dentist Medicaid Fraud

By Daniel Miller In every state, Medicaid covers comprehensive dental services for all enrolled children. Additionally, almost every state Medicaid program provides emergency dental services to enrolled adults. About two-thirds of the state Medicaid programs additionally cover at least some non-emergency dental services for enrolled adults. See id. Whistleblowers play a central role in [...]

By | 2018-08-27T15:30:20+00:00 August 27th, 2018|Medicaid Fraud|

Nevada False Claims Act

By William Ellerbe The Nevada False Claims Act (“Nevada FCA”) mirrors the federal False Claims Act (“FCA”) but operates at the state level. Enacted in 1999, the Nevada FCA penalizes people who defraud Nevada’s state or local governments. The Nevada FCA imposes civil liability on “[any] person who, with or without specific intent to defraud, [...]

By | 2018-08-24T10:16:26+00:00 August 24th, 2018|False Claims Act Information|
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