Category archive: False Claims Act

Fraud and Abuse Update: Inflation Adjusted Rate Hikes Coming Aug. 1 for False Claim Act and Anti-Kickback Civil Money Penalties

PROVIDERS TAKE NOTE: CIVIL MONEY PENALTIES FOR FALSE CLAIM ACT AND ANTI-KICKBACK STATUTE VIOLATIONS WILL NEARLY DOUBLE AUGUST 1ST The Department of Justice (DOJ) released an interim final rule recently to update the minimum and maximum civil money penalties (CMP) for violation of the False Claim Act (FCA). Providers should be aware that the increases…

Hospitals Beware – Inpatient Kyphoplasty Procedures Remain a False Claims Act Target

Kyphoplasty is a minimally invasive procedure used to treat certain spinal fractures often due to osteoporosis.  Since the filing of a qui tam action, more than 130 hospitals have entered settlements with the Department of Justice (DOJ) totaling approximately $105 million to resolve allegations that they mischarged Medicare for kyphoplasty procedures. On December 18, 2015,…

False Claims Update: OIG Continues to Focus on Ambulance Services

Reduction of fraud and abuse remains a focus of the government’s efforts to ensure providers accountability.  Recently, the Department of Justice (DOJ) announced a $3.199 Million settlement of alleged False Claims Act violations resulting from an ambulance “swapping” arrangement between a skilled nursing home and ambulance service (Regent settlement). Once again, the Department of Justice…

Recent Decision Concerning “Identification” Of Provider Overpayments And The False Claims Act

The Affordable Care Act (PPACA) expanded the False Claims Act (FCA) to require providers to report and return any overpayment within 60 days of identification. Just what “identification” means under this rule has been unclear until now. With the SDNY’s recent ruling in Kane v. Healthfirst, Inc., No. 1:11-cv-02325-ER (SDNY Aug. 3, 2015), there is…

Learning the Hard Way – Omnicare to Pay $124M False Claims Settlement

False Claims Act (FCA) allegations are serious business. Anti-Kickback Statute prohibits offering, paying, soliciting or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid and other federally funded programs. Omnicare learned the hard way just how serious FCA actions can be when a whistleblower made allegations against it. The Department of…

ALERT – Clinical Labs under Scrutiny by OIG

As health care costs rise and providers are faced with challenges to meet the needs and demands of consumers; Medicare looks for questionable payments made to providers to ensure federal dollars for healthcare are spent for medically necessary services as it seeks to reduce fraud and abuse in the provision of health care. One such…

False Claims Act Update – 16 Hospitals to Pay $15.69M Related to Medically Unnecessary Psychotherapy Services

On May 7, 2015, the Department of Justice reported settlement with 16 separate hospitals for medically unnecessary or unreasonable psychotherapy services. The claims under scrutiny were Intensive Outpatient Psychotherapy (IOP) services, which represent a variety of treatment methods. The services, while billed to Medicare by the providers, were performed on the providers’ behalf by Allegiance…

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