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Healthcare Fraud

Quest Diagnostics to Pay $1.79 Million to Settle Fraud Claims

A New Jersey-based diagnostic clinical laboratory has agreed to pay $1.79 million to settle claims it defrauded Medicare.Image source: Wikimedia Commons Under the guidelines of Medicare Part B, enrollees are entitled to coverage for medically necessary and essential diagnostic services, including bloodwork, x-rays, and similar imaging examinations. If a provider fails to [...]

By | 2018-07-20T11:23:16+00:00 September 7th, 2015|Healthcare Fraud|

Tennessee Hospital Agrees to Settle Allegations of False Billing and Unlawful Practices

The Regional Hospital of Jackson has agreed to pay $510,000 to settle allegations it engaged in medically unnecessary cardiac procedures and false billing. Of the various ways in which healthcare providers can violate the False Claims Act, ordering medically unnecessary procedures – particularly those involving the cardiac system [...]

By | 2018-03-25T15:42:09+00:00 August 20th, 2015|Healthcare Fraud|

Courts Considering Concept of Inflated ‘Risk Adjustment Scores’ Under the False Claims Act

The Centers for Medicare and Medicaid Services rely on provider-reported ‘risk adjustment scores’ to calculate appropriate reimbursement rates. According to a report published by the Center for Public Integrity, as many as six separate whistleblower lawsuits have been filed since 2010 alleging inflated ‘risk adjustment scores’ submitted to [...]

By | 2018-03-25T14:58:53+00:00 July 20th, 2015|Healthcare Fraud|

Vanguard Health Systems Agrees to Settle False Claims Act Allegations for $2.9 Million

Tennessee-based Vanguard Health Systems recently opted to settle extensive allegations of healthcare fraud for nearly $3 million. Vanguard Health Systems, which is based in Nashville, Tennessee, is accused of committing a number of violations under both the False Claims Act and the Stark Law, including illegal billing practices, [...]

By | 2018-03-26T09:28:22+00:00 July 16th, 2015|Healthcare Fraud|

Department of Justice Turns Eye Toward Settlement Over Off-Label Marketing of Conjunctivitis Drug

In a recent settlement, Merck has agreed to pay $5.9 million to settle claims it unlawfully marketed its conjunctivitis drug, AzaSite. When reimbursing for prescription medication, agencies like Medicare and Medicaid are only permitted to pay claims for drugs that are prescribed for their approved use. When a [...]

By | 2018-03-25T15:37:51+00:00 June 30th, 2015|Healthcare Fraud|

Connecticut Doctor Settles Allegations of Medicare Fraud

The United States Attorney for the District of Connecticut recently announced a $218,000 settlement against a Ridgefield, Connecticut, geriatric physician. In a small but mighty settlement against an experienced Connecticut physician, the Department of Justice recently exposed significant fraud and upcoding schemes within a Ridgefield office specializing in [...]

By | 2018-03-25T14:35:36+00:00 June 29th, 2015|Healthcare Fraud|

Florida Fertility Clinic Settles Upcoding Allegations With Department of Justice

The Jacksonville Center for Reproductive Medicine is alleged to have “upcoded” several fertility services performed by nurses and medical assistants.Image source: Flickr CC user COD Newsroom The Jacksonville Center for Reproductive Medicine (JCRM) recently settled with the Department of Justice amid allegations it billed the government for fertility [...]

By | 2018-03-26T01:53:34+00:00 May 5th, 2015|Healthcare Fraud|
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