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Long Term Care & Senior Living Blog

We offer updates on national on regional issues such as malpractice defense, regulatory compliance, labor and employment issues and estate planning.

Long Term Care & Senior Living Blog
May 4, 2016

Elder Fraud in Health Care Targeted by the DOJ

The U.S. Department of Justice (“DOJ”), in trying to initiate quicker enforcement actions and prosecutions, has created several Elder Justice Task Forces to target health care providers who commit crimes in the service of the elderly. The Task Forces are comprised of representatives from federal, state and local law enforcement, the U.S. Department of Health and Human Services, state adult protective services agencies, long-term care ombudsman programs, U.S. Attorneys’ offices, state Medicaid fraud control units, and state and local prosecutors.

Long Term Care & Senior Living Blog
December 21, 2015

Hospitals Beware - Inpatient Kyphoplasty Procedures Remain a False Claims Act Target

Kyphoplasty is a minimally invasive procedure used to treat certain spinal fractures often due to osteoporosis. Since the filing of a qui tam action, more than 130 hospitals have entered settlements with the Department of Justice (DOJ) totaling approximately $105 million to resolve allegations that they mischarged Medicare for kyphoplasty procedures.

Long Term Care & Senior Living Blog
December 8, 2015

False Claims Update: OIG Continues to Focus on Ambulance Services

Reduction of fraud and abuse remains a focus of the government’s efforts to ensure providers accountability. Recently, the Department of Justice (DOJ) announced a $3.199 Million settlement of alleged False Claims Act violations resulting from an ambulance “swapping” arrangement between a skilled nursing home and ambulance service (Regent settlement). Once again, the Department of Justice news release announced that another ambulance provider came under the scrutiny of the Medicare Fraud Strike Force (HEAT), a joint effort of the FBI and HHS-OIG. The Department of Justice announced the prison sentences for the owner, operator and managers of ProMed Medical Transportation, a Southern California ambulance company, as a result of a Medicare fraud scheme involving fraudulent billing for ambulance services. The ambulance company conspired to bill Medicare for transportation that was not necessary, and had the paperwork altered to conceal the patients’ true medical conditions to create fraudulent conditions to justify the services. In addition to the prison sentences ranging from 24 months up to 108 months, the convicted billing manager and supervisor were ordered to pay restitution jointly and severally in the amount of $804,755.

Long Term Care & Senior Living Blog
June 25, 2015

ALERT - Clinical Labs under Scrutiny by OIG

As health care costs rise and providers are faced with challenges to meet the needs and demands of consumers; Medicare looks for questionable payments made to providers to ensure federal dollars for healthcare are spent for medically necessary services as it seeks to reduce fraud and abuse in the provision of health care. One such area is Clinical labs. As discussed below, these labs require prompt attention due to the significant increased scrutiny of their operations.