Author: Scott

What Does Retaliation Under the False Claims Act Look Like?

Case Study:  United States v. Novartis The recent United States v. Novartis case, provides a good example of how Whistleblower Retaliation against an employee might...

An Opportunity to be Heard: Improving Transparency and Fairness in Healthcare Enforcement Actions – Part Two

The United States Department of Health and Human Services (HHS) just released a new set of rules that are focused specifically on improving transparency and...

Improving Transparency and Fairness in Healthcare Fraud Enforcement Actions – Part One

HHS recently issued a new set of rules as part of a broader effort on HHS’s part to implement an executive order, issued two years...

The False Claims Act and the Importance of “Materiality”

The False Claims Act imposes liability on a person who knowingly makes a false record or statement that is material to a false or fraudulent...

Drummond v. BestCare: An “Open-and-Shut Case” of Medicare Fraud – Part Two

The Posture of the Case When It Came to the Fifth Circuit Court of Appeals We left off Part One discussing the fact that the...

Drummond v. BestCare: An “Open-and-Shut Case” of Medicare Fraud – Part One

Drummond v. BestCare Laboratory Services, 950 F. 3d 277 (5th Cir. 2020) is an important Medicare fraud case decided last year.  It uniquely has everything...

Medicare Hospitals Unsuccessfully Attempt Statutory Surgery to Recoup Lost Profits

Common sense wins out in the end.  And that is what happened in a Medicare Overpayment case just last week in the case of Fresno...

A Possible $1 Billion Loss Due to Improper Use of Malnutrition Codes in Medicare Billing

OIG released a report in July 2020 that uncovered improper billing by hospitals related to the use of “severe malnutrition” diagnosis codes.  The result of...

OIG Has Tried to Encourage CMS to Close a Drug Payment Loophole Twice, But CMS Won’t Budge

Government oversight can sometimes be a frustrating business.  That maxim is particularly true when it comes to persuading the Centers for Medicare & Medicaid Services...

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