Promote a compliant environment within your organization, before the whistle is blown. The most notable Medicare fraud cases in the last five years have been whistleblower cases in which someone with inside knowledge of a health system or physician practice (usually an employed physician or administrator) files suit against the employer under the federal False ...
Nov 15th, 2016
Let a case show you why it’s important for your healthcare system to Implement effective compliance programs. By Ann M. Bittinger, Esq. United States of America ex rel. Baklid-Kunz v. Halifax Hospital Medical Center is one case in a recent series in which U.S. attorneys sued health systems for paying kickbacks to their employed physicians, ...
Ensure everyone in your organization is on board to handle overpayments properly. Identifying and managing overpayments is more than good business practice; it’s a compliance necessity to avoid liability under the False Claims Act (aka, reverse False Claims Act) and Affordable Care Act (ACA). Under Section 6402(a) of the ACA, any identified overpayments under a ...
In Audit
Sep 15th, 2015
by John Verhovshek, MA, CPC What should you do if you are expected to code in a way that you suspect is abusive, or even fraudulent? First—before you take any action—be clear about what is being asked of you. Misunderstandings happen, and you don’t want to make accusations that you’ll later regret. Next, research your ...
Jun 3rd, 2015
by John Verhovshek The Supreme Court has ruled that the False Claims Act allows for multiple qui tam actions—or “whistleblower” suits—based on a single complaint. The unanimous decision in Kellogg, Brown & Root Services Inc. v. United States ex. rel. Carter, announced May 26, removed any assumption that “first to file” prevents subsequent suits based ...