Category: Medicare
False Claims Act and Whistleblower Retaliation – Legal Analysis of United States v. Novartis
In our previous blog post, we began the discussion of the recent Whistleblower Protection case of United States v. Novartis, where the employee (“Relator”) became...
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...