As efforts to increase the number of Americans who are vaccinated against COVID-19 ramp up, employees can expect to see more vaccine mandates in their workplaces. Over the summer, the California Department of Public Health issued orders requiring certain covered health care facilities and school districts to verify their employees’ vaccination status and implement mandatory regular testing of unvaccinated workers. On Sept. 9, as part of his comprehensive strategy to combat the spread of … [Read more...]
Government watchdog flags risk-adjusted Medicare Advantage payments
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...]
Workers prevail in California break pay case
Hourly workers in California who are not fully compensated for meal and rest breaks now have grounds to recover that shortfall following a recent California Supreme Court ruling. On July 15, the California high court unanimously ruled in Ferra v. Loews Hollywood Hotel, LLC that workers who are not given meal or rest breaks during their shifts are entitled to premium payments that factor in all non-discretionary payments they receive, not just their hourly wages. The lead plaintiff in the … [Read more...]
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