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July 2020 Archives

Did hospital execs & lab owners commit $1B in health care fraud?

The United States Department of Justice (DOJ) recently accused a group of 10 individuals of partaking in a health care fraud scheme that cost the government over $1 billion. The accused include hospital executives and diagnostic lab owners as well as billers.

CMS provides guidance on eligible telehealth services for 2021

The United States Centers for Medicare and Medicaid Services (CMS) recently released a publication outlining telehealth services that will be eligible for coverage in 2021. The agency’s list includes 39 telehealth-eligible services, such as:

Doctor loses license after suffering medical emergency

A pain management physician lost consciousness while on duty. Medical staff were able to promptly intervene and successfully treat the doctor. Shortly after the incident, the Texas Medical Board suspended his medical license. The Board's action triggers two important questions:

TX couple faces seven health care fraud charges

Government authorities recently accused a former surgeon turned business owner of running a criminal enterprise in Texas. The physician transitioned from practicing medicine within the operating room to serving as the owner of an orthopedic and spinal disorder clinic in the Fort Worth area. During his time as a business owner, government authorities state he committed multiple acts of health care fraud.

Novartis to pay millions to settle health care fraud claims

The government continues its crackdown on the use of bribes in the medical field. Although it is noble to better ensure physicians are motivated by patient need and not financial gain, the distinction between what is legal and what is not can be difficult to determine. A recent case provides an example of this distinction and the extreme penalties that can come with a violation.

Hospital system agrees to $16M settlement for decade old claim

The Department of Justice (DOJ) recently announced a southern hospital system, Piedmont Healthcare, Inc., had agreed to pay $16 million to settle allegations of wrongdoing. Both parties intend the settlement to resolve two separate legal claims.

Hospital fights allegations of false claims

Hospitals often face allegations of wrongdoing. In some cases, the allegations can be severe and can lead to serious financial penalties as well as criminal liability for individuals that are involved. In one recent example, former employees of a hospital from Tennessee claimed the hospital filed false documents to get money from the government.

Hospitals take on HHS over price disclosure rule

The United States Department of Health and Human Services (HHS) issued a rule in November that requires hospitals to disclose the rates they negotiate with insurance providers. The rule requires hospitals begin to provide this information to the public in 2021. In response to the rule, the American Hospital Association, Association of American Medical colleges, Children's Hospital Association and Federation of American Hospitals filed a lawsuit against the HHS, stating the agency did not have the authority to require hospitals to make the disclosure.

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