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Upcoding Medical Billing

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, […]

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

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 […]

What Pennsylvania Laws Protect Whistleblowers?

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 […]

Remuneration Under the Anti-Kickback Statute Includes Intangible Economic Benefits

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 […]

Home Healthcare Fraud and the False Claims Act

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 […]