Visiting Nurse Service Settles Alarming Long-Term Healthcare Fraud Allegations

For individuals in need of long-term care (i.e., a permanent stay in a nursing home), the options are to either self-fund the monthly charge or to apply for Medicaid benefits. As Medicare does not cover long-term care, patients in need of this vital service must be eligible by showing financial […]

Netherlands-Based Organon, Inc. Settles Healthcare Fraud Claims for $34 Million

The False Claims Act is not limited only to domestic instances of fraud against the government. To the contrary, companies headquartered in other countries are routinely targeted for fraud investigations, including a recent False Claims Act case against a Netherlands-based drug company now owned by the more familiar corporation Merck. […]

Dignity Health Agrees to Settle False Claims Act Case for $37 Million

Healthcare fraud is one of the most detrimental – and costly – forms of fraud, as it not only could increase premium rates for innocent policyholders, but can even compromise the quality of patient care. One of the most common forms of healthcare fraud involves illegal “upcoding” or unnecessary admittance […]

Examining the Distinction Between Conditions of Participation Versus Conditions of Payment

The statutory requirements of the False Claims Act are highly specific, requiring a precise intent to defraud the government out of taxpayer dollars. An emerging issue across several federal courts involves the pivotal distinction between conditions for participation in Medicare or Medicaid versus conditions for reimbursement for patients enrolled in […]

Tennessee District Court Approves Statistical Sampling in Pivotal False Claims Act Case

As we discussed yesterday, the False Claims Act is often triggered by widespread, pervasive, long-term fraudulent behavior–resulting in voluminous records and hundreds of thousands of invoices evidencing the fraudulent misconduct. As a result, courts have begun to consider whether the use of a statistical random sample of admissions or patient […]