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Health Care Investigations Archives

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 Federal of American Hospitals filed a lawsuit against the HHS, stating the agency did not have the authority to require hospitals to make the disclosure.

Doctor gets four years in prison for health care fraud

The United States Attorney’s Office recently announced a physician has pled guilty to criminal health care fraud charges. The charges are the result of a health care fraud investigation that led to over 15 criminal charges for four medical professionals.

CMS makes changes to ACO program: 5 things to know

The United States Centers for Medicare and Medicaid Services (CMS) recently announced changes to its Next Generation Accountable Care Organization (ACO) program. CMS explains these changes are an attempt to continue sufficient financial incentives to encourage higher quality outcomes for organizations that participate in value based arrangements.

OIG and coronavirus funds: 2 enforcement efforts in action

The current coronavirus pandemic has led various federal government programs to provide funds to struggling businesses. Some of these funds are set aside specifically for health care businesses. These funds often come with restrictions and improper use can result in fines and allegations of wrongdoing.

Some health care companies return federal funding

The United States Centers for Medicare and Medicaid Services (CMS) sent out federal funding to help qualifying businesses within the health care marketplace. These funds were part of the Coronavirus Aid, Relief and Economic Security Act. In an effort to better ensure medical care providers received the funds promptly, the agency decided to proactively deposit $30 billion to providers who had recently filed claims with Medicare.

CMS rule: A closer look at affiliation reporting for managers

As noted in a previous post, the Centers for Medicare and Medicaid Services (CMS) has a new rule that allows the agency to penalize those who fail to disclose affiliations with those who have had enrollment to Medicare or Medicaid previously revoked or denied.

Rule gives CMS authority to act against affiliates of bad actors

The Centers for Medicare and Medicaid Services (CMS) have a new rule that allows a more proactive approach to enforcement efforts. Lawmakers wrote the rule to provide another tool against health care fraud. According to the Federal Register, the Program Integrity Enhancements to the Provider Enrollment Process, has two main provisions.

Diagnostic lab accused of improper dealings with TX hospitals

The government has strict regulations when it comes to relationships between hospitals and diagnostics labs. These regulations were recently highlighted when the Department of Justice (DOJ) reached a multi-million-dollar settlement with a diagnostic lab over allegations the lab improperly billed federal healthcare programs.

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