Med-Net Compliance

JULY 20, 2022

A federal jury convicted a New York ENT doctor for defrauding Medicare and Medicaid by causing the submission of false and fraudulent claims for surgical procedures that were not performed. Specifically, between January 2014 and February 2018, the doctor billed Medicare and Medicaid approximately $585,000 and was paid approximately $191,000.

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Fraud Doctors Medicare Medicare 59

Health Law RX

JUNE 2, 2023

2] Companies that regularly submit claims to the federal government are familiar with the complex maze of rules and regulations that often govern them. 6] These government payor programs limit the amount pharmacies can charge for generic medications to the “usual and customary” price. [7] per 30-day supply). [9] June 1, 2023).

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Fraud Governance Medicaid Medicaid 52

Hall Render

APRIL 6, 2022

Turning to the present case, in Safeway , the relator alleged that the defendant engaged in the submission of false claims to the government when it “reported its ‘retail’ price for certain drugs as its ‘usual and customary’ price.” SuperValu Inc., of America v. Burr was applicable to lawsuits brought under the False Claims Act.

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Health Law Advisor

AUGUST 14, 2023

2] Centers for Medicare & Medicaid Services, Spotlight: Physician-Owned Hospital Expansion Exception Requests – Changes Effective October 1, 2023 , available at [link] (last accessed August 2, 2023). [3] 5, 2007) (emphasis added). [5] 2, 2023). [2] 2, 2023). [4] 2, 2023). [2] 2, 2023). [4] 2, 2023). [2] 2, 2023). [4] at 51020. [6]

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COVID-19 Medicare Medicare Public Health 52

Hall Render

JUNE 7, 2023

This practice implicated the pharmacies’ contracts with Pharmacy Benefit Managers (“PBMs”) as well as Medicaid and other federal health care programs. 47 (2007), the U.S. 47, 70 (2007). [10] 8] In Safeco Insurance Company of America v. Burr , 551 U.S. Safeway, Inc.). [2] at *6-7 [3] Id. [4] 4] 31 U.S.C. 3729(b)(1)(A). [6]

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Fraud Medicaid Medicaid Governance 40

Pharmacy Law Blog

FEBRUARY 13, 2018

Supreme Court decision in her case holding that the government could not freeze untainted assets. Her case continued in 2017 following a 5-3 ruling by the Supreme Court holding that the government could not freeze assets belonging to her that were not tied to the alleged fraud scheme. To read more on the U.S. Let’s see.

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Fraud Medicare Medicare Governance 40

Innovaare Compliance

FEBRUARY 9, 2021

Annually, the Centers for Medicare & Medicaid Services (CMS) releases star ratings, which measure the quality of care health plans deliver for its members. Launched in 2007, star ratings enable the CMS as well as consumers to compare health plans on metrics other than cost. Centers for Medicare & Medicaid. References.

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