What Is Unbundling Fraud For Whistleblowers

Medicare fraud is a serious and growing problem that has led to the government losing billions of dollars every year, and whistleblowers are essential in the fight against it. Unbundling fraud is one of the most common types of Medicare fraud and whistleblowers can help to stop it. In this blog post, we’ll look at

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Stark Law and Anti-KickBack Differences For Whistleblowers

The Anti–Kickback Statute and the Stark Law are two important pieces of legislation that are designed to protect patients from fraudulent medical practices and protect taxpayer dollars from being wasted on unnecessary medical care. While these two laws have similar goals, they are actually quite distinct and have different implications for medicare fraud enforcement and the

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Pharmaceutical Qui Tam Cases On The Rise

As the cost of healthcare continues to rise, the government is taking a closer look at pharmaceutical companies that are engaging in Medicare fraud. Pharmaceutical Medicare fraud occurs when a pharmaceutical company or its representatives attempt to defraud the government by overcharging for drugs, upcoding, or submitting false claims. Pharmaceutical companies are particularly vulnerable to misuse of Medicare funds or false claims

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Jacob Tubbs Cited By NPR About Fraudulent Hospital Admissions

Not all patients who are in the ER are admitted, and it is important that those that require in-patient levels of care are treated properly in the ER setting, but recent studies have shown that some for-profit hospital chains enact practices whereby they use quotas or incentives to fraudulently admit patients for inpatient care where

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Medical Testing and the False Claims Act

If the past year is any indication, companies and practitioners involved in medical testing are facing increasing scrutiny under the False Claims Act. We believe that recent trends show just how vital whistleblowers will be to addressing medical testing fraud in the near future.

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Telemedicine Fraud — Notable Cases and the Role of the Whistleblower

Not only has the use of telemedicine risen to unprecedented levels during the Covid-19 pandemic, but the Centers for Medicare and Medicaid Services (CMS) decided to relax Medicare coverage rules regarding telemedicine last year. As a result, telemedicine represents a relatively uncharted frontier in the health care industry, offering hopes of increased access and care

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Opportunities for Medicare Fraud Abound in Telemedicine; Qui Tam Whistleblowers Cases Will Likely Increase

During the Covid-19 pandemic, the number of Medicare fee-for-service (FFS) beneficiaries using telemedicine skyrocketed by 13,000%, according to CMS administrator Seema Verma. In fact, during a single three-month span in 2020, over 9 million Medicare FFS beneficiaries utilized some form of telehealth services. While the opportunity for increased medical access afforded by telemedicine is great,

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Recent Healthcare Fraud Developments — September 2021

Medicare fraud is as prevalent as ever, with billions of taxpayer dollars lost each year. However, recent developments show that the Department of Justice (DOJ) has renewed its emphasis on aggressively pursuing healthcare fraud through the False Claims Act (FCA) and recovering tens of millions of dollars in settlements for whistleblowers. Bayada Settles FCA Lawsuit

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Sutter Health to Pay $90 Million in Record Medicare Advantage Whistleblower Settlement

Sutter Health, the largest hospital system in Northern California, agreed last week to pay $90 million to settle recent allegations of Medicare Advantage fraud. This is the second largest Medicare Advantage fraud settlement ever reported and the largest such settlement brought under the False Claims Act. Between 15-30% of this amount will go to the

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Billing Fraud Recent Developments

Oglethorpe Inc. and Cardiologist Dinesh Shah settle billing fraud claims brought through the False Claims Act.

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