Although the deliberate offenders tend to get all of the attention, many if not most billing, coding and reimbursement violations are committed by labs that want to comply with the rules but find them … [Read more...]
Compliance Trends
Labs Using New Legal Defense to Shoot Down FCA Lawsuits Over Unclear Regulations
October 19, 2021
FALSE CLAIMS
Courts Create New Defense for False Claims Based on Reasonable Mistakes about Regulatory Requirements
September 28, 2021
The False Claims Act (FCA) bans labs and other providers from “knowingly” submitting false claims. “Knowingly” is a curious word. Medicare coverage and billing rules can be intricate, confusing and … [Read more...]
Enforcement Trends
Federal Courts Split on Government Dismissals of Qui Tam Claims
September 2, 2021
In 2018, the Justice Department (DOJ) ordered US Attorneys to aggressively seek dismissal of False Claims Act (FCA) whistleblower qui tam lawsuits that lack merit or don’t serve the government’s … [Read more...]
Enforcement Trends
Federal False Claims Act Recoveries Hit 5-Year High
August 26, 2021
For more than a decade, enforcement of the federal false claims act was a government cash cow. But in recent years, investment returns on the activity actually declined. That trend came to an end last … [Read more...]
Enforcement Trends
Federal Courts Split on Government Dismissals of Qui Tam Claims
August 10, 2021
In 2018, the Justice Department (DOJ) ordered US Attorneys to aggressively seek dismissal of False Claims Act (FCA) whistleblower qui tam lawsuits that lack merit or don’t serve the government’s … [Read more...]
Enforcement
Federal False Claims Act Enforcement Continues to Gather Steam
August 9, 2021
Despite the COVID-19 pandemic and continued sequestration of enforcement funds, federal false claims enforcement activity seems to be gathering momentum. Reversing recent trends, the federal Health … [Read more...]
Labs in Court
Self-Disclosing Saves Kentucky Lab Over $1 Million in False Claims Settlement
August 6, 2021
Case: A Kentucky-based lab that made heroic efforts to step up its COVID-19 testing early in the pandemic has agreed to shell $1.25 million for falsely billing Medicare, Medicaid, TRICARE and CHAMPVA … [Read more...]
Enforcement Trends
Federal Courts Split on Government Dismissals of Qui Tam Claims
July 29, 2021
In 2018, the Justice Department (DOJ) ordered US Attorneys to aggressively seek dismissal of False Claims Act (FCA) whistleblower qui tam lawsuits that lack merit or don’t serve the government’s … [Read more...]
Enforcement
Fraud Recoveries Grow as Feds Target Telemedicine and COVID-19 Add-On Test Scams
July 29, 2021
Despite the COVID-19 pandemic and continued sequestration of enforcement funds, the federal Health Care Fraud and Abuse Control Program (Program) reversed recent trends and recovered more money in FY … [Read more...]
Labs in Court
University of Miami Settles Lab Testing False Claim Charges for $22 Million
July 27, 2021
Case: In this particular case, “The U” stands for unnecessary, as in medically unnecessary lab tests billed to Medicare by the University of Miami’s lab and off campus hospital-based facilities. The … [Read more...]
