News & Analysis as of

Fraud False Billing Health Care Providers

Fraud is the making of false representations or engaging in deceptive behavior in order to unlawfully secure financial or personal gain. 
Goodwin

Aetna’s “Fraud Scheme” Lawsuit Against Radiology Group Highlights Health Plans’ Resistance to Private-Equity-Backed Providers

Goodwin on

On December 23, 2024, various Aetna affiliates (referred to hereafter as Aetna) filed suit against Radiology Partners, Inc., a national, private-equity-backed radiology group, alleging that Radiology Partners defrauded the...more

Bass, Berry & Sims PLC

HHS-OIG Set To Intensify Scrutiny of Grants and Contract Compliance: How to Prepare

Bass, Berry & Sims PLC on

As we detailed in a previous blog, on October 3, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) published a strategic plan to “safeguard[] the integrity of HHS grants and contracts.” The...more

Kerr Russell

Did I Commit Fraud?

Kerr Russell on

Question: I am under audit by a dental plan I participate with. The audit has identified a few issues in connection with how my billing employees have been submitting claims for payment. For example, the name of the treating...more

Bass, Berry & Sims PLC

Recap of Webinar: Billing, Coding, and Collecting for Infusion Services

Bass, Berry & Sims PLC on

Bass, Berry & Sims attorney Shannon Wiley, with Carine Leslie and Katie Garmon of PYA, P.C., recently discussed the complexities associated with billing, coding, and collecting for infusion services as part of the Infusion...more

Hendershot Cowart P.C.

Healthcare Providers: You May Be Liable for Billing Company Fraud, Negligence

Hendershot Cowart P.C. on

Physicians and practice managers: Keep an eye on medical billing or health services contractors acting on your behalf. Your practice is liable for any violations of state and federal healthcare fraud laws, including Stark...more

Wiley Rein LLP

2021 FCA Recoveries Bounce Back from Decade-Low . . . Maybe

Wiley Rein LLP on

On February 1, the U.S. Department of Justice (DOJ) announced the second-largest annual total recoveries in the history of the False Claims Act (FCA)—$5.6 billion—for FY 2021 (October 2020 – September 2021)...more

Health Care Compliance Association (HCCA)

Report on Medicare Compliance Volume 29, Number 25. News Briefs: July 2020

Report on Medicare Compliance 29, no. 25 (July 13, 2020)  -  Ophthalmic Consultants PA in Sarasota, Florida, agreed to pay $4.8 million to settle false claims allegations that it billed Medicare and other federal payers...more

Dorsey & Whitney LLP

Dialysis Provider Settles Whistleblower Lawsuit for $450 Million

Dorsey & Whitney LLP on

The Department of Justice and dialysis provider DaVita Healthcare Partners recently finalized a $450 million agreement settling claims that the company intentionally inflated Medicare billings. The parties had filed a joint...more

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