Health Care Fraud Report Index-Summary

HEALTH AND HUMAN SERVICES DEPARTMENT (HHS)

– Budget FY2011, proposal, 107
– Claims database upgrades, House panel hearing, 200
– Elder abuse advisory board, nominations sought, 611
– Enforcement, commitment, 109
– Fraud prevention focus of efforts, 729
– Medicare Fraud Strike Force, expansion, 22; budget proposal, 107; House panel hears testimony on program, 199
– Office of Inspector General

See INSPECTOR GENERAL (IG), HHS

HEALTH CARE AND EDUCATION RECONCILIATION ACT

– State compliance review sought by Senator, 375
– Transparency and disclosure initiatives, Insight, 320

HEALTH CARE REFORM, FEDERAL

– Anti-fraud provisions

– – Reconciliation bill

See LEGISLATION, FEDERAL, HR 4872

– – Reform bills

See LEGISLATION, FEDERAL, HR 3590, HR 3962, S 2964

– Fraud, reality vs. rhetoric, Insight, 92
– Increased scrutiny predicted, Insight, 265
– Key provisions in House and Senate bills, BNA Special Report, 49
– Obama plan released, 157
– Outlook, 42
– PPACA

See PATIENT PROTECTION AND AFFORDABLE CARE ACT (PPACA)

– Reconciliation bill

See HEALTH CARE AND EDUCATION RECONCILIATION ACT

HEALTH CARE REFORM, STATE

– Colo., cost-saving bills introduced, 177

HEALTH INSURANCE

– Accounting scheme allegation, WellCare settles case (M.D. Fla.), 658
– Breast cancer, drop in coverage alleged, HHS response, 396
– Cal., fraudulent plans, 2009 report, 179
– Chiropractic center, insurer's fraud suit may proceed (N.D. Ill.), 858
– Compliance budgets, survey, 13
– Dentists' RICO claims against insurers inadequately pled (11th Cir.), 429
– Disclosure of documents required by insurer alleging fraud (D. Mass.), 464
– Embezzlement, refusal to dismiss indictment upheld in part (2d Ct.), 858
– Fake insurance sales, TRO issued (M.D. Tenn.), 711
– Fla. regulators warn against solicitations from unauthorized firms, 222
– Fraud savings, Blue Cross Blue Shield reports rise, 464
– HMOs

See HEALTH MAINTENANCE ORGANIZATIONS (HMOs)

– Kickbacks, preauthorization services for referrals not fined, IG, 785
– Missouri

– – Bogus plan operators targeted, 179
– – Broker sentenced for Medicaid fraud (Mo. Cir. Ct.), 517
– – Discount plans, crackdown announced, 811

– New York

– – Small businesses, insurer fine, 134
– – State insurance plan, billing fraud, 180

– Pharmacy technicians

– – Falsely billing insurer, guilty plea (N.D. Ala.), 616
– – Insurance fraud charged (E.D. Mo.), 430

– PPACA

– – Insurance scams since enactment, Sebelius addresses, 331
– – Loss-ratios should include fraud expenses, groups say, 464; tax treatment, draft rule released, 791

– Record retrieval, excessive fees alleged, amended filing allowed (E.D. La.), 558
– Vitamin marketing probed by Regence Blue Cross, 428
– Whistleblower suit filed against WellCare (M.D. Fla.), 576
– Workers' comp plan, CVS settles drug inflation claims (Mass. Super. Ct.), 760

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)

– Business associates of covered entities, HHS proposes extending rule, 573
– Conn., data on portable disk drive (D. Conn.), 73
– Dermatologists, whistleblower/privacy concerns, amended case (E.D. Tenn.), 456
– E-records, incentive funds entice schemes, professionals say, 205
– Hospital employee allegedly disclosed patient data, indictment (W.D. Pa.), 756
– Qui tam suits, discovery, ex parte patient interviews allowed (N.D. Ill.), 575

HEALTH MAINTENANCE ORGANIZATIONS (HMOs)

– La., HMO executives' convictions upheld (5th Cir.), 251
– N.Y., MA sales agent licensing and prompt payment violations, HMO fined, 393

HEALTH RECORDS

See generally MEDICAL RECORDS

HEMODIALYSIS

See END-STAGE RENAL DISEASE (ESRD)

HHS

See HEALTH AND HUMAN SERVICES DEPARTMENT (HHS)

HIPAA

See HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)

HIV

See AIDS AND HIV

HMOs

See HEALTH MAINTENANCE ORGANIZATIONS (HMOs)

HOME HEALTH CARE

– Agency owner's sentence for bogus orders affirmed (6th Cir.), 455
– Ambulatory care accreditation, expansion to include home options considered, 765
– Bogus claims filed by individual, conviction affirmed (9th Cir.), 520
– Cal. law allows paycheck fraud and elder abuse, report, 301
– Disclosure, DOJ requests Amedisys documents, 789
– Falsifying patient forms, nurse indicted (S.D. Tex.), 758
– Florida

– – Billing scheme, three defendants sentenced (S.D. Fla.), 798
– – Clinic owner, nurses and recruiter plead guilty (S.D. Fla.), 661
– – Medicare scheme, guilty pleas (S.D. Fla.), 745

– Grand larceny, N.Y. clinic pleads guilty, 630
– Miscoding alleged, some qui tam claims revived (7th Cir.), 457
– N.J. couple plead guilty (N.J. Super. Ct.), 669
– N.C., two providers sentenced (W.D.N.C.), 555
– Patient Choice Home Health Care, Detroit, arrests (E.D. Mich.), 70; sixth guilty plea, 424; assistants plead guilty, 620; guilty plea, 805; sentence, 843
– Personal care services

– – Employee indicted (E.D. La.), 25; time sheets falsified, employee sentenced, 580
– – False documentation, employee sentenced for Medicaid fraud (E.D. La.), 340
– – False documents, indictments (N.M. Dist. Ct.), 221
– – Services never rendered, prison sentence for employee (E.D. La.), 25

– Physical therapy

– – Failure to file qui tam complaint under seal, dismissal upheld (6th Cir.), 840
– – Primary Med., unqualified employees, convictions (S.D. Miss.), 451; sentences, 750
– – Statewide Med., trial delayed (S.D. Miss.), 28

– Prevention, recommendations, 64
– Unnecessary services

– – Houston, seven people indicted (S.D. Tex.), 584
– – Mich., unnecessary visits, $9.5M settlement, 23

– Untrained personnel

– – Cal., six people convicted (C.D. Cal.), 612
– – N.Y. agencies settle, 37

HOSPICE CARE

– Medicare cap enforcement temporarily ceased (E.D. Ark.), 693
– Physician services, questionable Medicare Part B claims identified, IG, 792
– Wrongful discharge, nurse need not report unlawful acts to licensing board (Md.), 428

HOSPITALS

– Accountable Care Organizations (ACOs)

See QUALITY OF CARE

– Accreditation, interim staffing effectiveness standards, 163
– Adverse events

– – Reporting requirements, compliance, 12
– – Screening methods, problems, 203

– Ancillary service exception, hospitals seek inclusion, 730
– Discovery of DOJ memos (D. Idaho), 169
– EMTALA issues

See PATIENT DUMPING

– False claims

– – Am. Hospitals Assn. letter on alleged inappropriate probes, 735
– – Auditor-caused false claims alleged, suit dismissed (S.D.N.Y.), 755
– – Medicaid reimbursement claims, WellStar/Ga. settlement, 762
– – Nonprofit Cal. hospital settles charges (S.D. Cal.), 806

– Infusion therapy

– – Conn. hospital settles billing claims, 207
– – Fla., clinic owner arraigned (S.D. Fla.), 21

– Kickbacks

See ANTI-KICKBACK LAWS

– Kyphoplasty, nine hospitals settle claims, 407
– Medicaid

– – Disproportionate share payments, state-owned hospitals, IG, 572
– – Place-of-service codes, incorrect payments reported, IG, 688
– – Supplemental payments, limits, 15

– Medical necessity fraud

See MEDICALLY NECESSARY SERVICES

– Medicare reimbursement, settlement (D.N.J.), 26
– Medication errors, 13 Cal. facilities, penalties, 131
– Neurosurgeon, loan payments (S.D. Cal.), 124
– New York

– – Floating Hospital, NYC, charges settled (S.D.N.Y.), 506
– – Limitations periods, charges untimely filed (S.D.N.Y.), 252
– – Outlier payments inflated, claims settled (D.N.J.), 211

– Outlier billing claims, settlement, 744
– Pain

See PAIN MANAGEMENT

– Philadelphia hospitals resolve overbilling claims, 657
– Pleading lacks particularity in qui tam suit against ambulatory surgery center (E.D. Va.), 662
– Quality of care

See QUALITY OF CARE

– Qui tam suit, hospital referrals, dismissal reversed (9th Cir.), 697
– RAC

– – Overpayment determination, report adopted (M.D. Fla.), 694
– – Reviews, administrative burden in hospitals, survey, 767; auditor overlap, inconsistencies noted by Am. Hospital Assn., 768

– Referrals

– – Inducing for services, settlement, 10
– – Self

See Self-referrals, this heading

– Rehabilitation

– – Overpayments, IG, 546
– – Therapy not provided, Mass. hospital settlement, 161

– Research

– – Alzheimer's disease, case charging data alteration dismissed (D. Mass.), 844
– – Funds falsely obtained (S.D.N.Y.), 29; qui tam suit to proceed, 454; psychiatrist and hospital, damages set, 664

– Self-referrals

– – Exceptions for whole and rural hospitals, CMS proposed rule, 607
– – PPACA, Stark Law exceptions tightened, 543
– – Rush Univ. hospital settles Stark law claims (N.D. Ill.), 249
– – S.C. hospital violated Stark law, not FCA (D.S.C.), 335; new trial on FCA charges granted, 503
– – “Technical Stark violations,” focus emphasized, Special Report, 471
– – Two-track review process urged, 609

– Suspension of doctor reportable to NPDB (11th Cir.), 800
– Unnecessary procedures, amended complaint ordered in qui tam suit (E.D. La.), 657
– Whistleblowers

– – Bad faith pleading, hospital may seek sanctions (W.D.N.Y.), 216; sanctions imposed, 511
– – Inflated outlier payments, N.J. hospital settles (D.N.J.), 247
– – Retaliation for qui tam suit, CEO (W.D. Ky.), 30