Healthcare Fraud

What is Hospice Fraud?

By Russell Paul Medicare Part A covers hospice care when a patient is certified as “terminally ill.” See e.g. 42 C.F.R. §§ 418.20, 418.22. “Terminally ill” means that a patient’s medical prognosis is for a life expectancy of six months or less due to the patient’s particular disease if it runs its normal course. See [...]

How to Report a Clinic for Healthcare Fraud

By Shauna Itri The state and federal governments pay hundreds of billions of dollars each year for pharmaceutical drugs, medical devices, hospital care, outpatient services, physician visits, and nursing home care. In making payments for these services, the government relies on clinics, companies, and individuals to abide by the law and submit accurate reimbursement [...]

What is Physical Therapy Medicare Fraud?

By Joy Clairmont Physical therapy Medicare fraud is when a provider fraudulently bills Medicare for physical therapy services. This fraud can also extend to other types of therapy services for Medicare beneficiaries, such as occupational or speech therapy. This particular fraud has been the subject of several successful qui tam lawsuits: in 2016, the [...]

What is the Difference Between Fraud and Abuse?

By Arthur Stock The qui tam statutes permit whistleblowers to report companies engaged in either “fraud” or “abuse” directed against the United States to the government. If this information leads to a successful qui tam lawsuit, the whistleblower is eligible to receive a portion of any monetary recovery the government receives. Many states have [...]

Anti-Kickback Medicare Part B Fraud Under the Federal False Claims Act

Waiving co-payments and deductibles required under Medicare Part B is a basis for a whistleblower to bring a claim under the federal False Claims Act About the Medicare Part B Program Title XVIII of the Social Security Act prescribes coverage requirements under Part B of the Medicare program. Medicare Part B covers services and items [...]

3 Types of Qui Tam Off-Label Marketing Cases

1. Off-Label Marketing vs. Off-Label Prescribing The Food and Drug Administration ("FDA") requires that drugs be proven to be safe and effective for a particular use before they can be marketed.  The FDA's approval is always limited to use or uses for which the manufacturer has submitted evidence of safety and efficacy. For example, if a [...]

False Claims Actions May Rise Under Medicare Part D

A recently unsealed action brought under the False Claims Act is one of the first to allege claims related to Medicare Part D.  Medicare contracts with private entities known as Part D sponsors to administer prescription drug plans.  A sponsor may use subcontractors to obtain and provide the medications.  Medicare  makes certain monthly payments based on a [...]

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