Health Care Investigations

Coverage by medical insurance is important for more than just patients—it is also important for those who operate in the health care industry. Businesses that operate in this market often depend on payments from insurance companies to continue operations....

The Recovery Audit Contractor Program is one group that contracts with the government ot correct inaccurate Medicare payments. Those who disagree with the program’s findings can appeal the process. However, one of the biggest critiques of the appeals process is...

The Southern District of Texas recently accused a Texas pharmacy owner of an elaborate health care fraud scheme. During the investigation, the prosecution gathered evidence to support allegations a city official was also involved in the scheme. The accusations were...

Healthcare fraud occurs when the government makes an accusation that someone filed false healthcare claims for financial gain. The government can accuse medical professionals throughout the healthcare field of a violation. Examples include: Physicians. Billing for...

Psychiatric facilities must operate while maintaining a difficult balance: provide the care patients need while not discharging them at a time they could injure themselves or others. A failure to navigate this balance wisely can result in allegations of criminal...

Navigating the intricacies of insurance payments is difficult, even for hospital officials. One local hospital is attempting to figure out what went wrong that led to an insurance company accusing the hospital of fraudulent billing practices.Practices elaborated: Was...

The Department of Justice continues to crack down on allegations of bribery in the healthcare industry. In the latest case, the government accused a Texas surgeon of paying and receiving bribes in relation to his medical practice.The scheme allegedly involved the...

The False Claims Act (FCA) makes it illegal to use false or fraudulent claims to seek payment from government sources, like Medicare and Medicaid. This law is complex. Court cases have questioned the best way to apply the FCA to establish a violation. These cases...

Lawmakers recently passed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) Act. This proposal passed with bipartisan support and was signed into law by President Donald Trump on October 24, 2018. The SUPPORT Act will have a...

Audit activity by government regulators and private payers has been on the rise. These investigations ramped up throughout 2017 and accelerated through 2018. The dramatic increase in audits is likely connected to the price cuts implemented with the new Medicare Part...