In September, the U.S. Department of Health and Human Services’ Office of Inspector General issued a report raising concerns that some Medicare Advantage companies inappropriately used chart reviews and health risk assessments, or HRAs, to receive higher risk-adjusted payments. The OIG found that 20 of the country’s 162 MA companies accounted for a disproportionate share of $9.2 billion in payments from diagnoses that were only reported on chart reviews and HRAs. Of the 20 companies, one … [Read more...]
Biden DOJ to continue focus on health fraud
The U.S. Department of Justice’s Civil Division remains focused on prosecuting healthcare fraud despite a changing of the guard in Washington, a DOJ official told a group of lawyers in late June. In an address to the American Health Law Association’s Annual Meeting, Michael Granston, deputy assistant general for the DOJ’s Commercial Litigation Branch, emphasized that prosecuting such cases remains a top priority for the department under the Biden Administration. That’s a continuation from … [Read more...]
Keller Grover, Constantine Cannon and Kleiman Rajaram Announce Record $90 Million False Claims Act Whistleblower Settlement with Sutter Health
Sutter Health settles closely watched whistleblower lawsuit alleging it violated the False Claims Act by submitting inaccurate and unsupported medical information on tens of thousands of patients enrolled in Medicare Advantage. SAN FRANCISCO, Aug. 31, 2021 /PRNewswire/ -- Keller Grover, Constantine Cannon, and Kleiman Rajaram announce the landmark $90 million False Claims Act settlement against Sutter Health on behalf of their whistleblower client, Kathy Ormsby, over allegations … [Read more...]
Five Ways Hospice Providers Use Terminally Ill Patients to Rip Off Taxpayers
Hospice care is the provision of specialized palliative treatment for terminally ill patients, focused not on curing them but making their last days as comfortable as possible. Hospice has gone from a grassroots movement on the outskirts of the U.S. medical establishment to a massive, multibillion-dollar industry. And as it has come of age, it has increasingly attracted the same type of fraud, waste, and abuse that plagues U.S. healthcare at large. Hospice treatment has been covered by … [Read more...]
Whistleblowers Stop Nursing Home Fraud and Patient Harm – With help from the False Claims Act
Healthcare fraud puts patients’ lives at risk and costs billions of dollars every year. Nursing homes, which house vulnerable patients away from loved ones and the outside world, are especially fertile breeding grounds for healthcare fraud schemes. While government agencies have stepped up their enforcement efforts, nursing home workers who witness fraud are in the best position to put it to a stop—and thanks to federal and state whistleblower laws like the False Claims Act, a single principled … [Read more...]