Category: Hospital Fraud

Be More Than An Ethical Bystander: Become a Healthcare Whistleblower

With each New Year comes an avalanche of resolutions. We start afresh and then ease back into our old habits as the months pass. The...

Hospitals in Trouble for Improperly Billing Medicare and Medicaid Health Care Programs

St. Michael’s Medical Center in Newark, New Jersey recently resolved allegations with the Department of Justice that it falsely billed Medicare and Medicaid for medically...

California Hospital Agrees to Settle With Department of Justice for Millions

The Department of Justice recently announced that Tri-City Medical Center, a hospital located in Southern California, has agreed to pay over $3.2 million to resolve...

Substantial Whistleblower Rewards are Available for Exposing Hospitals that Ignore National Coverage Determinations

False Claims Act (FCA) liability arise when a hospital bills Medicare for items or services that violate CMS’ National Coverage Determinations’ coverage requirements. This was...

Hospital Fraud: It’s Not Just the Money

Hospitals that engage in fraud by encouraging and/or allowing unnecessary procedures, without adequate utilization review; and/or allowing patients to be admitted unnecessarily, are subjecting those...

Are Some Medical Device Companies Trying to Induce Hospitals to Perform Unnecessary Inpatient Procedures?

As medical technology has advanced, more and more surgical procedures have become outpatient procedures. Medicare has encouraged this migration out of the hospital by only...

DOJ Shows Continued Interest in Ferreting Out Inappropriate Inpatient Care

Oftentimes, potential healthcare whistleblowers inquire about whether the Justice Department has an interest in pursuing particular healthcare fraud schemes. The best indicators of DOJ interest...

Is Your Hospital-Employer Sitting on Known Medicaid or Medicare Overpayments?

In 2009, Congress strengthened the False Claims Act so that employees and the government could bring an action against a provider that knowingly retained an...

More to Come on the Heels of Tenet Healthcare Payout?

A 2009 False Claims Act complaint accused Tenet of hospital fraud by paying kickbacks to doctors based on referrals. As the result, the complaint contends...

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