When I was a kid, I built models, usually of airplanes and of cars. Some hospitals and medical groups build whistleblowers. I’m not kidding you. These healthcare entities ignore employees or partners who come to the business or group with complaints related to billing irregularities, upcoding, lack of medical necessity, and so on. In doing…
This past Friday, April 15, 2016, a Santa Clara County, California jury awarded the insurer Aetna a $37,452,199.00 judgment in a lawsuit against Bay Area Surgical Management, LLC, a surgery center management company, a number of its managed ASCs, and three of Bay Area’s executives. The ASCs were out of network as to Aetna plans….
The next time a hospital tells you that they’ve checked the deal with their lawyers and that it’s okay, don’t take their word for it.
The federal Anti-Kickback Statute (the “AKS”) makes it a crime to pay remuneration to induce a referral of a federal health care program patient. Many mistakenly believe that the AKS focuses only on cash remuneration, as in “here’s $100 for the case.” They believe that it’s somehow okay for a referral-receiving physician or group to…
The Stark Law makes it illegal for a hospital to bill Medicare for certain services referred by physicians with whom the hospital has a financial relationship unless the arrangement falls within one of the law’s specific exceptions.
“Psst! Send me some referrals. I can’t pay you directly, so I’ll pay your spouse.”
In a very real sense, all physicians give a limited warranty – it’s called malpractice liability.
“Psst! Send me some referrals. I can’t pay you directly, so I’ll pay your spouse.” “Hey, keep your voice down. Send me some referrals. I can’t pay you directly, so set up an LLC and I’ll pay it.” Oh, what a tangled web we weavewhen first we practice to deceive! I doubt that Sir Walter…
Citizens Medical Center, a county-owned hospital in Victoria, Texas, paid the United States government $21,750,000 to settle, without admitting wrongdoing, a whistleblower suit under the False Claims Act. The whistleblowers, competing physicians, will receive $5,981,250 from the recovery.