Medicaid pays for approximately 20% of all healthcare expenses in the United States, over $600 billion each year. Well over 500,000 healthcare providers, ranging from hospital chains to individual doctors to ambulance helicopter pilots, receive payments from Medicaid every year. Inevitably a few of the providers will try to defraud the program to line [...]
In every state, Medicaid covers comprehensive dental services for all enrolled children. Additionally, almost every state Medicaid program provides emergency dental services to enrolled adults. About two-thirds of the state Medicaid programs additionally cover at least some non-emergency dental services for enrolled adults. See id. Whistleblowers play a central role in defending the Medicaid [...]
In today’s case, we look at the Nashville-based nonprofit hospice center Alive Hospice, who is alleged to have admitted patients who did not meet the criteria for hospice coverage, and to have intentionally defrauded the government by submitting claims on behalf of these patients. While Alive Hospice representatives publicly disagreed with the allegations, the [...]
With one of the most active and often-used state False Claims Acts, New York has once again taken aim at alleged misconduct within the healthcare industry. According to a recent announcement by the New York Attorney General’s Office, the popular Walgreens pharmacy and its subsidiary Trinity Homecare, LLC have reached a $2.5 million settlement [...]
Healthcare fraud cases are not limited solely to medical doctors. Misconduct among dentists and oral surgeons is also a major issue plaguing government-funded healthcare programs. In today’s case, we review a recent instance of healthcare fraud involving an Atlanta-area dentist alleged to have submitted false claims to Medicaid for procedures that either did not [...]
According to the details of a recent settlement under the New York False Claims Act, the Mental Health Association is alleged to have made handwritten alterations to progress notes which were subsequently submitted to Medicaid officials pursuant to an official requested audit. The settlement, which amounted to $304,000, came about after two former MHA [...]
The Medicaid program is a need-based health insurance program run by the federal and state governments. In most instances, the federal government matches state funding dollar-for-dollar. However, states generally have latitude in determining the type, extent and frequency of services covered. In Illinois, certain medical transport services (aside from emergency ambulance or air transport) [...]
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 [...]
DaVita Healthcare Partners is one of the nation’s leading providers of dialysis services, with clinics in 46 states. DaVita agreed to one of the largest healthcare fraud settlements in fiscal year 2014 with regard to its alleged submission of false claims to programs like Medicare and Medicaid for reimbursement. As we reported in 2014, [...]
On November 12, 2014, the U.S. Court of Appeals for the Seventh Circuit affirmed an earlier dismissal by a U.S. District Court in Wisconsin regarding allegations of unlawful billing practices between a retail pharmacy and Medicaid. More specifically, the relator alleged that the pharmacy improperly inflated the costs of certain drugs as sold to [...]
