In today’s case, we explore a somewhat increasing phenomenon of unlawful and fraudulent billing practices pertaining to palliative (i.e., end of life) care. When it comes to palliative care, Medicaid and Medicare enrollees may receive coverage for hospice services as long as certain criteria are met. Namely, there must be […]
Home-based nursing care is considered somewhat of a luxury under government healthcare regulations. This means there are limited circumstances under which programs like Medicare, Medicaid, or TRICARE will reimburse a company for home-based services. Patients must meet strict eligibility criteria prior to receiving reimbursement. Under current guidelines, a medical doctor […]
A recent press release from the Department of Justice alleged that several hospitals within the nationwide Community Health System (CHS) chain made unlawful donations to various county governments in violation of state and federal Medicaid laws. The scheme occurred under New Mexico’s supplemental Medicaid program, which primarily served rural and […]
Under the federal False Claims Act, it is unlawful for individuals and businesses to submit claims for reimbursement or funding based on fraudulent, falsified, or exaggerated facts. If a company submits improper claims and evidence shows there was intent to defraud (as opposed to accidental fraud), the business may have […]
The Washington Attorney General’s Office lauded its 2015 recovery of $3.35 million on behalf of state taxpayers and the state Medicaid program. In today’s case, we explore a 2015 recovery involving the nearly decade-long overbilling scheme alleged to have been perpetrated by a Seattle-area dentists’ office regularly treating both pediatric […]