Category: False Claims Act
In its earnings statement, the company disclosed that it received a civil investigative demand from the Department of Justice. Specifically, the agency was looking for information on Oak Street’s relationships with third-party marketing agents and transportation services.
The California-based health system will pay a hefty price to resolve allegations that it knowingly submitted inflated diagnosis codes for certain Medicare Advantage beneficiaries to receive higher payments. Sutter Health does not admit any liability in the matter.
Overturning a district court’s decision that had earlier vacated the Medicare Advantage Overpayment Rule, the DC Circuit opened a Pandora’s Box of DOJ False Claims Act litigation last week.
While Covid-19 requires physicians and hospitals to be more efficient than ever, a number of legal structures must be considered before providers consolidate their resources. To optimize patient care and ensure rapid payment for services, avoid running afoul of these sometimes counterintuitive regulatory schemes.
The vendor has agreed to pay $18.3 million to settle allegations that it violated the False Claims Act by offering illegal kickbacks to boost EHR sales. The company denies any wrongdoing and said it agreed to settle to “put the matter behind us.”
The whistleblower case alleged that an electronic health records company acquired by Konica Minolta cheated on certification tests to hide software issues.
A recently unsealed whistleblower case filed by the Department of Justice accuses Cigna of fraudulently overbilling for its Medicare Advantage plans. Allegations claim the company submitted unsupported diagnoses that resulted in “billions” in overpayments.