Legal Insights & Articles

Can Whistleblowers Remain Anonymous?

By Daniel Miller The biggest concern most whistleblowers (aka“Relators”) raise is confidentiality. They want to the do the right thing, but they fear that doing the right thing could cost them their job or their career. These concerns are real. It is widely known that people or companies that defraud the government are capable [...]

By | 2018-08-21T11:59:24+00:00 August 21st, 2018|False Claims Act Information|

Upcoding Medical Billing

By Jonathan DeSantis When a provider treats a Medicare patient, the provider must tell Medicare what services were provided so that Medicare can reimburse the doctor the correct amount. Certain services have higher reimbursement amounts than others –a more serious condition will generally be more expensive for the provider to treat and thus, the [...]

By | 2018-09-25T13:37:30+00:00 August 20th, 2018|Healthcare Fraud|

Anti-Kickback Statute Safe Harbor: Personal Services and Management Contracts

By Russell Paul The Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b) (“AKS”), prohibits anyone from knowingly and willfully offering, paying, soliciting, or receiving remuneration in order to induce reimbursable business under federal or state healthcare programs. The Department of Health and Human Services has enacted safe harbor regulations that define practices that are not subject to [...]

By | 2018-08-16T11:54:37+00:00 August 16th, 2018|Healthcare Fraud|

What Pennsylvania Laws Protect Whistleblowers?

By Susan Schneider Thomas The broadest whistleblower protection comes, appropriately enough, from a statute known as the Pennsylvania Whistleblowers Act. 43 P.S. §§1421 et seq. In pertinent part, the statute provides that: “No employer may discharge, threaten or otherwise discriminate or retaliate against an employee regarding the employee’s compensation, terms, conditions, location or privileges of [...]

By | 2018-08-15T11:45:15+00:00 August 15th, 2018|False Claims Act Information|

Remuneration Under the Anti-Kickback Statute Includes Intangible Economic Benefits

By Shauna Itri The Anti-Kickback Statute (“AKS”) prohibits anyone from: “solicit[ing] or receiv[ing] any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind . . . in return for referring an individual to a person for the furnishing . . . of any item or [...]

By | 2018-08-14T10:54:49+00:00 August 14th, 2018|Healthcare Fraud|

Home Healthcare Fraud and the False Claims Act

By William Ellerbe Home healthcare is a vital service that many Americans rely on. Unfortunately, because of some aspects of the delivery system for home healthcare, and because the patients who receive home healthcare services may be the targets of unscrupulous providers, there is the potential for fraud in home healthcare. Examples of home [...]

By | 2018-08-08T10:50:24+00:00 August 8th, 2018|Healthcare Fraud|

Pennsylvania Supreme Court Decision Upholds Damages for Emotional Distress for Whistleblower

By Susan Schneider Thomas In a unanimous decision strongly supporting whistleblowers and recognizing the public interest that they serve, the Pennsylvania Supreme Court confirmed that an employee terminated for reporting suspicious activities by a government sub-contractor could recover non-economic damages – essentially, damages for emotional distress – in addition to economic damages for loss [...]

By | 2018-08-06T11:00:56+00:00 August 6th, 2018|False Claims Act Legal News|

Use of Hospital-Employed Non-Physician Providers by Private Physicians May Violate the Anti-Kickback Statute

By Shauna Itri The Anti-Kickback Statute (“AKS”) prohibits any person or entity from offering, making, soliciting, or accepting remuneration, in cash or in kind, directly or indirectly, to induce or reward any person for purchasing, ordering, or recommending or arranging for the purchasing or ordering of federally-funded medical goods or services. Whoever knowingly and [...]

By | 2018-08-03T09:50:43+00:00 August 3rd, 2018|Healthcare Fraud|

Michigan Medicaid False Claims Act

By Joy Clairmont The Michigan Medicaid False Claims Act encourages individuals with information related to Medicaid fraud being perpetrated against the State of Michigan to file a lawsuit on behalf of the State and share in any recovery. Michigan Medicaid False Claims Act Liability As the name implies, the Michigan Medicaid False Claims Act [...]

By | 2018-08-01T10:37:13+00:00 July 31st, 2018|False Claims Act Information|
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