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By Carole C. Schriefer, R.N., J.D., The Health Law Firm On July 14, 2016, a Colorado federal judge partly dismissed allegations against several surgical centers in claims filed by insurance companies Aetna and UnitedHealthcare. The judge disagreed that the two surgical centers committed fraud by waiving patient fees or violated antitrust laws by sending hefty bills to the insurers.
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On July 7, 2016, the US Fourth Circuit Court of Appeals dismissed a lower court judgment and remanded to state court a qui tam action alleging certain medical laboratories defrauded Virginia’s Medicaid program. The whistle blower action was brought under the Virginia Fraud Against Taxpayers Act (VFATA).
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law If you are a physician, dentist, nurse, psychologist, pharmacist, physician assistant, nurse practitioner, massage therapist or other licensed health professional whose license has been recently revoked or suspended, there may still be hope. As a matter of course, you would be required to immediately stop practicing or risk being prosecuted for unlicensed practice, which is a felony.
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On June 15, 2016, A medical diagnostics company owner found guilty of Medicare and Medicaid fraud for billing $8 million for X-rays whose botched analysis by amateurs led to the death of two patients was sentenced in Maryland federal court to 10 years in prison, the US Department of Justice said.
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By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law Regulatory authorities in the United States are increasingly scrutinizing noncompetition provisions (sometimes called restrictive covenants) included as part of employment agreements. The main focus is close examination of provisions restricting junior-level and low-wage employees.
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On June 30, 2016, a Florida heart surgeon agreed to pay $2 million and release any claims to $5.3 million in suspended funds allegedly owed to him because of allegations of improperly billing Medicare, Medicaid and TRICARE. He is doing this to resolve a False Claims Act (FCA) suit, sometimes called a "whistle blowers" or "qui tam" suit.
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On June 22, 2016, Federal officials completed a three-day nationwide takedown announcing charges against 301 medical professionals who allegedly defrauded Medicare of more than $900 million in fraudulent billings. US Attorney General Loretta Lynch and US Health and Human Services (HHS) Secretary Sylvia Mathews Burwell said the three-day takedown represents the largest number of arrests, spread over the
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By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On June 22, 2016, Federal officials completed a three-day nationwide takedown announcing charges against 301 medical professionals who allegedly defrauded Medicare of more than $900 million in fraudulent billings. US Attorney General Loretta Lynch and US Health and Human Services (HHS) Secretary Sylvia Mathews Burwell said the three-day takedown represents the largest number of arrests, spread over the
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On June 24, 2016, Prime Healthcare Services, Inc. (Prime), a California-based company whose mission was stated to be turning around struggling hospitals, is alleged to have run a systematic scheme to defraud the federal government. Prime was allegedly able to defraud the federal government by forcing doctors to provide medically unnecessary services in order to maximize Medicare reimbursements, the US
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law On June 13, 2016, the American Medical Association (AMA) implemented new guidance for the ethical practice of telemedicine. These new guidelines are aimed to help physicians understand how their fundamental responsibilities may play out differently when patient interactions occur through telemedicine, compared to traditional patient interactions at a medical office or hospital.
By Michelle Bedoya, J.D., and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law This is part two of two in a blog series in which the effects and scope of OIG exclusion on health care professionals will be discussed. Click here to read part one of this blog series. Pursuant to Sections 1128 and 1156 of the Social Security Act, the US Department of Health and Human Services Office of Inspector General ("OIG") has the authority to exclude individuals and e
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