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 payments under Medicare Advantage risk adjustment. 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. … [Read more...]
Healthcare Fraud Whistleblower Cases Stay a DOJ Priority
The U.S. Department of Justice’s Civil Division remains focused on prosecuting healthcare fraud, including healthcare fraud whistleblower cases, 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 … [Read more...]
Record $90 Million False Claims Act Settlement with Sutter Health Announced by Keller Grover and Co-Counsel
Sutter Health's False Claims Act settlement resolves a 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 … [Read more...]
California Meal Premium Pay: Workers Prevail in Break Pay Case
Hourly workers in California who are not fully compensated for meal and rest breaks now have grounds to recover that shortfall in California meal premium pay following a recent state 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 … [Read more...]
Labor Code 2802: Protect Your Rights in the Work-From-Home Era
Office costs, not surprisingly, took a dive during the pandemic-driven work-from-home era. Looking ahead, if U.S. employers embraced remote work just half the time for workers who are both able and willing to work from home, they could collectively save more than $500 billion a year, according to an estimate from Global Workplace Analytics. The firm predicts at least a quarter of the workforce will work from home for multiple days a week post-pandemic. That means workers should be informed … [Read more...]
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