The Government Accountability Office was requested to look into how effectively the funding provided for the Centers for Medicare & Medicaid Services’ (CMS) Medicare Integrity Program (MIP) are being used to address the integrity of the Medicare Program. GAO took into account use of funding by CMS for MIP, how CMS evaluates MIP’s efficiency,
St. Francis Hospital and Medical Center has settled a False Claims Act complaint for $516,527 amidst claims that it overbilled Medicare for a prostate cancer treatment. The drug Lupron is an injectable that is used to treat prostate cancer in men, as well as endometriosis and fibroids in women. The treatment for males and females each have a separate billing code,
Following the conviction of cardiologist Dr. John R. McLean on six charges of health care fraud offenses, Peninsula Regional Medical Center in Salisbury, Maryland has agreed to pay $1.8 million to settle allegations that the hospital failed to prevent the doctor from inserting medically unnecessary cardiac stents. The $1.8 million settlement is being paid under the False Claims Act.
The New York Times reports that hospice care is under the microscope for care and treatment that may not be necessary. The amount of money spent on hospice care grew from $2.9 billion in 2000 to more than $12 billion in 2009. The increase is attributable to Medicare regulations some years ago that demonstrated that allowed for hospice care as a cost-effective way of caring for individual near the end of life.
On June 13, 2011, it was announced that the U.S. Department of Justice would intervene in a False Claims Act suit against Eli Hage Korban, M.D., and two Tennessee hospitals, Jackson-Medicine Country General Hospital and Regional Hospital of Jackson. The suit is before Judge Bernice Bouie Donald, U.S. District Court for the Western District of Tennessee,
On Thursday, the United States Supreme Court struck down a Vermont law that blocked drug manufacturers’ use of prescription drug information in marketing campaigns designed to sell new drugs to physicians. Although the law was designed to hold down health care costs and shield physicians from harassing marketing campaigns by preventing manufacturers from using prescription drug information to craft marketing campaigns,
American Medical Response (“AMR”), one of the country’s largest private ambulance services, will pay the United States government $2.7 million to resolve allegations that it defrauded Medicare and other federal health insurance programs.
The allegations against AMR were originally brought by several former employees, who alleged that AMR coded “basic life support” calls as “advanced life support,” which are reimbursed at a higher rate by Medicare.
Three related companies, Areté Sleep LLC, Areté Sleep Therapy LLC and Areté Holdings LLC, have agreed to pay the United States Department of Justice $650,000 to settle claims that the Areté companies defrauded Medicare in violation of the False Claims Act. The settlement resolves claims that Areté submitted false claims to Medicare for diagnostic sleep tests performed by technicians lacking the licenses or certifications required by Medicare’s rules and regulations.
On May 26, 2011, Judge William J. Haynes, Jr. awarded the United States $82,642,592.00 in damages after granting summary judgment in favor of the government on its False Claims Act (“FCA”) claim against Fresenius Medical Care Holdings, Inc. The award was based on treble damages under the FCA of $38,873,592 and $43,769,000 in civil penalties.
On May 13, 2011, in a case of apparent first impression, Judge John Gleeson of the United States District Court for the Eastern District of New York held that medical services defendants may not implead their billing company where the Government, after intervening in a False Claims Act suit, asserts claims for unjust enrichment and payment by mistake.
If you are aware of any person, corporation or entity that you think may be violating the Federal False Claims Act or a State False Claims Act, contact us today.