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February 27, 2017 Healthcare Fraud

A Laboratory’s Liability for Medically Unnecessary Lab Tests under the False Claims Act, Part II

In Part I of this blog series, we discussed when lab tests are considered “reasonable and necessary” under the False Claims Act (“FCA”) and therefore reimbursable by government health insurers such as Medicare and Medicaid, as well as a laboratory’s responsibility for ensuring that lab tests submitted for reimbursement are […]
February 24, 2017 Healthcare Fraud

A Laboratory’s Liability for Medically Unnecessary Lab Tests under the False Claims Act, Part I

This article addresses the liability of a diagnostic testing laboratory under the False Claims Act (“FCA”) for conducting lab tests that are ordered by a doctor and submitting claims for payment to government health insurers, such as Medicare and Medicaid, for those lab tests when those tests are not medically […]
February 22, 2017 Healthcare Fraud

“Medically Necessary” Ambulance Services Under the False Claims Act

A non-intervened False Claims Act case filed against Medstar, an ambulance company, settled for $12.7 million on January 17, 2017.  The qui tam case was filed on October 4, 2013 in the Federal District Court of Massachusetts under the caption United States ex rel. Dale Meehan v. MedStar et als, […]
January 25, 2017 Healthcare Fraud

Medicare Advantage Fraud Part I: Presentment of False Claims by Medical Providers to Medicare Advantage Organizations

Medicare fraud is one of the prime drivers of litigation under the False Claims Act (“FCA”). Under traditional Medicare, service providers are directly reimbursed with federal government funds. In 2003, Congress significantly expanded the availability of an alternative to traditional Medicare known as Medicare Advantage. Medicare Advantage differs from traditional […]
November 13, 2015 Healthcare Fraud

Federal Government Investigating Soaring Pharmacy Reimbursement Claims in Military

According to a startling article published in the Wall Street Journal, several compounding pharmacies are facing possible liability under the False Claims Act for illegal billing practices surrounding customers enrolled in coverage through the military’s TRICARE healthcare insurance program. Described by investigators as “widespread fraud,” the investigation spans across at […]
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