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October 30, 2017
Healthcare Fraud
What is Medi-Cal Fraud?
Medi-Cal is the name of the State of California’s Medicaid program, as well as certain state healthcare programs. Medi-Cal is administered by the California Department of Health Services and accounts for more than $40 billion in annual expenditures – nearly one-quarter of the state’s entire budget. Medi-Cal provides health coverage […]
October 23, 2017
Grant Fraud
NIH Grants: A Risk Area for Fraud
By Sherrie Savett Background The National Institutes of Health (“NIH”) awards billions of dollars to support medical and scientific research in the area of health and diseases. NIH invests approximately $32.3 billion each year in research grants to recipient organizations.[1] There are strict requirements for grant approval. Only 7 – […]
October 20, 2017
Healthcare Fraud
Medicare Fraud: Billing for Services Not Rendered
Imagine the following scenario: a patient with Medicare sprains her ankle and sees a doctor for one 15 minute appointment. The doctor then bills Medicare as if he had seen the patient for five 15 minute appointments over the course of a month. The doctor figures that Medicare will never […]
October 16, 2017
Healthcare Fraud
What is the Medicare Fraud Strike Force?
Although fraud against the federal and state governments occurs in many different industries, there is always a lot of attention paid to healthcare fraud because it involves such enormous government expenditures, and it has such a huge impact on the beneficiaries of government healthcare programs. That impact can be through […]
October 13, 2017
Grant Fraud
Prestigious Universities and Research Institutions Commit Grant Fraud Too
By Sherrie Savett Major universities rely on government grant money to supplement their revenues from tuition, endowments, and contributions. Purely research entities which are not full universities and where there is little or no tuition revenue depend even more heavily on government grant money, especially in the area of medical […]
October 11, 2017
Healthcare Fraud
The Anti-Kickback Statute vs. The Stark Law
There is much confusion between the Federal Anti-Kickback Statute and the Stark Law because both laws deal with remuneration related to improper referrals. But there are fundamental distinctions between the two laws. Anti-Kickback Statute [42 U.S §1320a-7b(b)] The federal Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b), (“AKS”) arose out of congressional […]
October 9, 2017
Healthcare Fraud
What is the Stark Law?
Section 1877 of the Social Security Act (“the Act”) (42 U.S.C. 1395nn) is also known as the physician self-referral law and is commonly referred to as the “Stark Law.”[1] The Stark Law was enacted in 1989 with the simple purpose of curbing physician self-referral. It was originally titled the Ethics […]
October 6, 2017
False Claims Act Information
A Relator’s Reliance is Irrelevant in a Public Disclosure Bar Inquiry
By Sherrie Savett and Jonathan DeSantis The False Claims Act (“FCA”) contains a public disclosure bar which, generally speaking, prohibits a relator from pursuing FCA claims where the false or fraudulent conduct on which the claims are based has already been publicly disclosed.[1] Various courts have concluded that the public […]
October 4, 2017
False Claims Act Information
Dismissing a False Claims Act Case: Is the Whistleblower Still Eligible for a Reward?
Consider the following scenario: A whistleblower files a complaint against a defendant under the False Claims Act (“FCA”). Then, the whistleblower voluntarily dismisses that complaint (perhaps because the government has declined to intervene, and the whistleblower does not wish to pursue the case at that time.) But then, the government […]
October 2, 2017
Rule 9(b)
False and Misleading Statements by Omission Can Be Actionable Under the False Claims Act
In bringing a claim under the False Claims Act (“FCA”), typically there are some sort of false or fraudulent statements made to the government. See 31 U.S.C. § 3729(a)(1)(A), (B). However, it should be noted that FCA claims may be committed by an affirmative misrepresentation or omission. See Universal Health […]
September 29, 2017
News
Aetna to Provide Emergency Relief to Members Affected by HIV/AIDS Privacy Breach
Aetna announced yesterday that it is now offering emergency relief for individuals harmed by Aetna’s mailing in July 2017 that disclosed information about HIV/AIDS medication through a large transparent window on the envelope.
September 29, 2017
False Claims Act Information
Declined vs. Intervened False Claims Act Cases
The False Claims Act allows a private individual to bring a case on behalf of the federal government for fraud against the government. In other words, if an individual (a “relator”) knows of another person or entity who is cheating the government through fraud, the False Claims Act allows the […]
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