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What is Cost Report Fraud?

Cost report fraud occurs when nursing homes, hospitals, and other healthcare providers for patient care falsely submit claims to the government for reimbursement. Medicare Part A healthcare providers that are paid under the fee-for-service based system can abuse federal government funding by: Inflating their patient care costs; Seeking reimbursement from […]

What is Phantom Billing?

Medicare fraud broadly refers to any individual, company or corporation who acts intentionally to steal money from the federal government. “Phantom billing” is a specific kind of Medicare fraud, as well as the most common. Phantom billing occurs when healthcare providers submit claims for reimbursement to the government for services […]

What is Best Price Fraud?

“Best Price” is a term used in connection with Medicaid reimbursement for brand name prescription drugs. Essentially, a drug manufacturer is required to charge Medicaid no more than whatever its best (lowest) price is to a non-government (or commercial) payor. Because Medicaid does not buy drugs outright and furnish them […]

Objective Falsity Requirement Under the False Claims Act

Can a False Claims Act case go forward where the only evidence of whether the services at issue were medically necessary are two competing and opposing medical opinions? In a prior blog, we discussed recent holdings in AseraCare I, AseraCare II and Vista Hospice[1].  The main issue addressed in those […]

Differences in Medical Opinion Under the False Claims Act

Courts have recently grappled with the issue of whether a Relator can maintain a case under the False Claims Act (“FCA”) where she retains an expert that says the medical services provided were not medically necessary and the defendant’s medical service provider or its retained expert says the exact opposite […]