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Blog Browse: What can recent FCA decisions tell us about the Seventh Circuit pleading standard for health care billing fraud claims?

Health Law Checkup

Can a whistleblower successfully allege Medicaid/Medicare fraud if the whistleblower lacked direct access to records related to the alleged fraud? While the appellate circuits are still split on this issue, we look at recent decisions that indicate a possible shift in the Seventh Circuit’s pleading standard.

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Rethinking Senior Scams?

Bill of Health

Following the findings of “The Age of Fraud,” I’d hypothesize that this way in which we think of scams both feeds and is fed by the apparent misconception that they are a relatively bounded problem for older adults. Social views about fraud and scams would, no doubt, be difficult to change quickly.

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Healthcare Providers’ Role in Preventing Fraud, Waste, and Abuse 

American Medical Compliance

Fraud, waste, and abuse (FWA) in healthcare present significant challenges, causing substantial financial losses, eroding public trust, and compromising the quality of patient care. Unlike fraud, waste is not necessarily intentional but results from inefficiencies.

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Zocdoc swings back at ousted CEO's fraud allegations

Mobi Health News

The online appointment booking service called for a dismissal and re-filing of the former CEO's lawsuit, and outlined a financial rebound since his dismissal in a new blog post.

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Using Compliance Software To Prevent Healthcare Fraud, Waste, and Abuse

MedTrainer

Healthcare fraud, waste, and abuse is a costly problem for both public and private payers. The National Health Care Anti-Fraud Association estimates financial losses due to healthcare fraud could be as much as $300 billion annually. Keep in mind that these are just examples of provider fraud!

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False Claims Act Retaliation Decision Calls into Question the Heightened Burden for Employees Whose Duties Include Compliance and Fraud Investigation

Hall Render

The United States District Court for the Eastern District of Wisconsin recently issued a decision involving protections for employees whose jobs involve the investigation of fraud. This category of individuals is sometimes called a “fraud alert employee.” Since 2009, the FCA’s anti-retaliation provision,(codified at 31 U.S.C.

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Indiana Physician Fraud Conviction Highlights Compliance Risks

Hall Render

Health care fraud remains a significant focus for federal and state enforcement agencies, with particular attention placed on the integrity of Medicaid and Medicare billing. This disparity highlights the difficulty in accurately assessing the risks and potential penalties associated with health care fraud violations.

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