Community Health Network (CHN) in Indiana has agreed to pay $345 million to settle false claims allegations that it paid over-the-top salaries to hundreds of physicians and rewarded them for their referrals in violation of...more
2/20/2024
/ Anti-Kickback Statute ,
Civil Monetary Penalty ,
Compensation ,
Competition ,
Compliance ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Employment Contract ,
Enforcement Actions ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare ,
Healthcare Fraud ,
Hospitals ,
OIG ,
Physicians ,
Stark Law ,
Whistleblowers
H. Lee Moffitt Cancer Center & Research Institute Hospital Inc. in Tampa, Florida, has agreed to pay $19.564 million to settle false claims allegations over claims submitted to federal health care programs for items and...more
2/20/2024
/ Clinical Trials ,
Compliance ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Billing ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
HIPAA Privacy Rule ,
Medical Records ,
Medicare ,
OCR ,
Provider Self-Disclosure Protocol ,
Settlement
Report on Medicare Compliance Volume 32, no 29 (August 2023)
In a new Medicare transmittal (12,202), CMS introduced a new place of service (POS) code (27) for “Outreach Site/Street.” POS 27 is defined as “a non-permanent...more
Report on Medicare Compliance Volume 32, no 25 (July 2023)
The former chief hospital executive of Bayonne Medical Center (BMC) in New Jersey has filed a False Claims Act (FCA) lawsuit alleging the hospital and two others...more
7/18/2023
/ CARES Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Coronavirus/COVID-19 ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare ,
Hospitals ,
HRSA ,
Overpayment ,
Provider Relief Fund ,
Whistleblowers
HealthOne Critical Care Transport Service Inc., doing business as MedicOne Medical Response of Marion, Illinois, has agreed to pay $302,124 to settle allegations it improperly billed Medicare for scheduled, non-emergency...more
12/6/2022
/ Ambulance Providers ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
False Billing ,
Healthcare ,
Medical Billing Codes ,
Medicare ,
Non-Emergency Medical Transportation (NEMT) ,
OIG ,
Overpayment ,
Settlement
Report on Medicare Compliance 31, no. 14 (April 18, 2022) -
Michigan gynecologic oncologist Vinay Malviya, M.D., has agreed to pay $775,000 to settle false claims allegations in connection with medically unnecessary...more
4/20/2022
/ Audits ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Hospitals ,
Medicaid ,
OIG ,
Physicians ,
Settlement Agreements ,
Unnecessary Medical Procedures ,
Work Plans
Report on Medicare Compliance 31, no. 14 (April 18, 2022) -
The Department of Justice (DOJ) said April 11 it has intervened in a whistleblower lawsuit against Methodist Le Bonheur Healthcare (MLH) in Memphis, Tennessee,...more
Report on Medicare Compliance 31, no. 9 (March 14, 2022) -
A federal jury on March 8 convicted New Jersey rheumatologist Alice Chu for defrauding Medicare and other health insurance programs, the Department of Justice...more
Report on Medicare Compliance 30, no. 32 (September 13, 2021) -
John Peter Smith (JPS) Hospital in Fort Worth, Texas, agreed to pay $3.3 million to settle false claims allegations in a case with a hot risk area, a...more
9/16/2021
/ Billing ,
Centers for Medicare & Medicaid Services (CMS) ,
Chief Compliance Officers ,
Compliance ,
Corporate Integrity Agreement ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Care Providers ,
Hospitals ,
Medicare ,
OIG ,
Overpayment ,
Personal Liability ,
Physicians ,
Settlement Agreements ,
Whistleblowers
Report on Medicare Compliance 30, no. 7 (February 22, 2021) -
A Michigan woman is the first in the nation to be charged criminally with misappropriating money from the Provider Relief Fund (PRF), the Department of Justice...more
2/25/2021
/ Ambulatory Surgery Centers ,
Biden Administration ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Coronavirus/COVID-19 ,
Criminal Prosecution ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Electronic Medical Records ,
Embezzlement ,
Enforcement Actions ,
Enforcement Authority ,
Health Care Providers ,
HIPAA Privacy Rule ,
HIPAA Violations ,
Home Health Care ,
Indictments ,
Medicare ,
OCR ,
OIG ,
Provider Relief Fund ,
Right of Access ,
Settlement Agreements
Report on Medicare Compliance 30, no. 4 (February 1, 2021)
- Correction: Medicare’s home oxygen national coverage determination has been waived during the public health emergency. RMC’s Jan. 25 issue stated otherwise. The...more
Report on Medicare Compliance 29, no. 42 (November 23, 2020)
- CMS said Nov. 16 that the Medicare fee-for-service improper payment rate dropped to 6.27% in FY 2020 from 7.25% last year, although CMS had to “modify”...more
12/1/2020
/ Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Fee-for-Service ,
Health Care Providers ,
Healthcare Fraud ,
HIPAA Violations ,
Medical Records ,
Medicare ,
Medicare Advantage ,
OCR ,
OIG ,
Right of Access ,
Settlement
Report on Medicare Compliance 29, no. 39 (November 2, 2020) -
Medtronic USA Inc., a medical device maker, has agreed to pay $8.1 million to settle allegations it violated the False Claims Act by paying kickbacks to induce...more
11/9/2020
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Home Health Agencies ,
Home Health Care ,
Kickbacks ,
Medical Devices ,
Medicare ,
Settlement ,
Telecommunications ,
Telehealth
Report on Medicare Compliance Volume 29, no. 32 (September 14, 2020) -
Wheeling Hospital in West Virginia has agreed to pay $50 million to settle a False Claims Act (FCA) lawsuit over physician compensation, the Department...more
Report on Medicare Compliance 29, no. 21 (June 8, 2020) -
Whether an organization shows its commitment to compliance with dollars is a new focus of the second update to guidance on evaluating compliance programs from the...more
Report on Medicare Compliance 29, no. 6 (February 17, 2020) -
Tenet Healthcare Corp. and an affiliated hospital, Desert Regional Medical Center, have agreed to pay $1.41 million to settle False Claims Act (FCA)...more
2/19/2020
/ Compliance ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Hospitals ,
Kickbacks ,
Medicaid ,
Medical Equipment ,
Medicare ,
Physicians ,
Settlement ,
TRICARE ,
Unnecessary Medical Procedures ,
Whistleblowers
Report on Medicare Compliance 29, no. 5 (February 10, 2020)
- David Laufer, the former chief of the Prosthetics and Orthotics Department at Walter Reed National Military Medical Center in Bethesda, Maryland, was charged...more
2/18/2020
/ Compliance ,
Criminal Prosecution ,
Department of Justice (DOJ) ,
Failure To Disclose ,
False Accusations ,
False Statements ,
FBI ,
Fraud ,
Gifts ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Medical Supplies ,
Medicare ,
Patient Privacy Rights ,
Retaliation ,
Whistleblowers ,
White Collar Crimes
Report on Medicare Compliance 29, no. 2 (January 20, 2020) -
- The HHS Office of Inspector General has updated its Work Plan, which includes an item on early discharges from inpatient rehabilitation facilities to home...more
1/27/2020
/ Civil Monetary Penalty ,
Compliance ,
Criminal Prosecution ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Durable Medical Equipment ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Medicaid ,
Medicare ,
Medicare Fraud ,
OIG ,
Psychiatrists ,
Settlement ,
TRICARE ,
Whistleblowers
Report on Medicare Compliance 29, no. 1 (January 13, 2020) -
The Department of Justice (DOJ) said Jan. 7 it has filed a False Claims Act lawsuit against Community Health Network, an integrated health care system in central...more
Report on Medicare Compliance 28, no. 44 (December 16, 2019) -
One way to find out whether compliance and integrity have seeped into the bones of an organization is asking people who would know. There may be a compliance...more
12/16/2019
/ Attorney General ,
Audits ,
C-Suite Executives ,
Compliance ,
Compliance Monitoring ,
Corporate Integrity Agreement ,
Corporate Monitoring ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Executive Compensation ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Incentives ,
Medicare ,
OIG ,
Physicians ,
Stark Law
Report on Medicare Compliance 28, no. 42 (November 25, 2019)
- In a surprising CMS memo that just surfaced, top CMS attorneys echo the sentiments of the Department of Justice about the limits of enforcement actions based...more
11/26/2019
/ Azar v Allina Health Services ,
Comment Period ,
Compliance ,
Department of Justice (DOJ) ,
Durable Medical Equipment ,
Enforcement Actions ,
Fee-for-Service ,
Guidance Documents ,
Home Health Care ,
Medicare ,
Medicare Part B ,
Notice and Comment ,
Payment Rates
Report on Medicare Compliance 28, no. 41 (November 18, 2019) -
- North Carolina physician Damian Brezinski and his medical group, Wilmington Health, agreed to pay $244,000 to settle false claims allegations in connection...more
11/18/2019
/ Compliance ,
Conflicts of Interest ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Clinics ,
Medical Devices ,
Medicare ,
Physician-Owned Distributors ,
Settlement ,
TRICARE ,
Unnecessary Medical Procedures
Report on Medicare Compliance 28, no. 39 (November 4, 2019) -
? The former CEO of Putnam County Memorial Hospital in Unionville, Missouri, pleaded guilty to one count of conspiracy to commit health care fraud, the Department...more
11/13/2019
/ Blood Tests ,
CEOs ,
Compliance ,
Criminal Convictions ,
Department of Justice (DOJ) ,
Fraud and Abuse ,
Guilty Pleas ,
Healthcare Fraud ,
Hospitals ,
Medicare ,
Medicare Beneficiaries ,
Patient Safety ,
Physicians