Last week, the House and Senate passed the “Red Flag Program Clarification Act of 2010.” The Act limits the definition of “creditor” to a person who obtains or uses consumer reports in connection with a credit transaction, furnishes information to consumer reporting agencies in connection with credit transactions, or advances…
The United States Justice Department reported that in 2009 it collected $3 billion from pursuing health care fraud and other false claims against the federal government. More than 80% of the recoveries were from healthcare fraud, including qui tam actions under the False Claims Act. Bloomberg News reported that Tony…
The proposed purchase of the Detroit Medical Center by Vanguard Health Systems Inc. has been conditionally approved by the Attorney General of Michigan Mike Cox. This sale would bring a purported $1.5 billion in funding for the center. The deal is tentatively set to take place on December 31, 2010…
As the focus on health care fraud continues within the federal government, Department of Health and Human Services Kathleen Sebelius and Attorney General Eric Holder recently participated in the third regional health care fraud prevention summit in Brooklyn, New York. The stated purpose of the summit was to bring together…
The United States Supreme Court refused to hear a legal challenge to the healthcare reform law, the Patient Protection and Affordable Care Act (PPACA). The Court declined without comment to hear the case originally filed in federal court in California by Steve Baldwin and the Pacific Justice Institute. The plaintiffs…
The device manufacturer, ELA Medical, Inc. agreed to pay the United States $9,178,000 to settle allegations that it violated the False Claims Act by giving kickbacks to cardiologists in exchange for the cardiologists ordering and causing hospitals to order ELA’s cardiac devices. The settlement resolves a qui tam action from…
The Centers for Medicare and Medicaid Services (CMS) published a proposed rule on November 5 regarding RAC activities for Medicaid programs. Section 6411 of the Patient Protection and Affordable Care Act (PPACA) requires states to contract with one or more Medicaid RACs by December 31, 2010. By that date, states…
Cardiac Pacemaker Implantations and Cardiac Defibrillator Implantations were two of the most targeted services from an overpayment standpoint during the RAC demonstration period. This makes them potential prime targets for the permanent RACs in the future. As such, sufficient documentation of the need for services provided at the inpatient level of…
The U.S. Justice Department filed a lawsuit against Blue Cross Blue Shield of Michigan (BCBSM) on Monday, October 18. The Justice Department alleges that BCBSM violated antitrust laws by using its strong presence in the market to increase prices for its competitors, which resulted in Michigan residents paying higher health…
In September the Joint Commission announced that it will begin to accredit patient-centered medical home models for physicians by July 2011. A medical home model is a method to deliver care that is based on the ability to demonstrate evidence-based protocols, self-management education and care coordination with specialists and other…