Healthcare Fraud

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 to the AKS. See [...]

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 home healthcare fraud that [...]

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

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 willfully solicits or [...]

What is Hospice Fraud?

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 42 U.S.C. § [...]

How to Report a Clinic for Healthcare Fraud

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 requests. Unfortunately, experience [...]

What is Physical Therapy Medicare Fraud?

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 United States reached [...]

What is the Difference Between Fraud and Abuse?

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 similar laws. Typically, [...]

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 [...]

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