Health Care Fraud Report Index-Summary

SANCTIONS

See also PENALTIES
– Ambulance/municipality deal, no kickback sanctions, IG, 830
– Bad faith pleading, hospital may seek sanctions (W.D.N.Y.), 216; sanctions imposed, 511
– Discovery delays, qui tam suits (M.D. Pa.), 76
– Medicare, retroactive beneficiary liability, no sanctions for waiving, IG, 548

SCREENING

See TESTS AND SCREENING

SELF-REFERRALS

– Certification claims, Tenet Healthcare counsel charged (S.D. Fla.), 295; case time-barred, 382
– Compliance with Stark Law, Outlook, 42
– DOJ predicted to litigate more Stark law cases, 496
– Hospitals

– – Anesthesiologists/Carlisle hospital pact, claims go to trial (M.D. Pa.), 336
– – 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
– – Two-track review process urged, 609

– Ill. doctor-owned firm, IG settlement, 571
– Imaging and radiation therapy, GAO study on Medicare spending sought, 378
– Medicare Payment Advisory Comm'n, in-office ancillary care discussed, 63; role of Stark law considered, 206
– Outlook, 42
– Self-disclosure protocol for Stark violations, CMS releases, 784; reduced repayment discussed at forum, 814; fundamental changes, Insight, 862
– Stark exceptions for e-records, comments sought on data collection burdens, 735
– “Technical Stark violations,” focus emphasized, Special Report, 471
– Third-party arrangements, Special Report, 138

SERVICE OF PROCESS

– Qui tam suit, physical therapists vs. clinic, timeliness (D.N.J.), 125

SKILLED NURSING FACILITIES (SNFs)

– Civil monetary fine imposed after buyer paid fine (2d Cir.), 553
– Employee exclusion list, failure to check, Conn. facility fined, 409; employee sentenced (D. Conn.), 664
– False claims for therapy services, conviction upheld (7th Cir.), 213
– Inflated costs, obstructing audit, convicted owner not denied effective counsel (C.D. Cal.), 453
– Medicare, “under arrangements” pharmaceuticals provider, discovery ordered (D. Utah), 661
– Quality of care

– – Ark., patients in immediate jeopardy, penalty (8th Cir.), 22
– – Failure to minimize accident risk, civil fine (7th Cir.), 420
– – Failure to report changed condition, immediate jeopardy finding upheld (6th Cir.), 582
– – N.C., Medicare safety rules, penalties (4th Cir.), 117

SMALL BUSINESSES

– Health insurer fine, N.Y. program, 134

SNFs

See SKILLED NURSING FACILITIES (SNFs)

SOFTWARE

– Charitable donations for use of software not kickbacks, IG, 650
– Data management

See ELECTRONIC HEALTH RECORDS

– Fraud detection, role of data mining techniques explored, 831
– Hospitals, kickbacks, survey sent, 65
– Innovative technology to fight fraud

See LEGISLATION, FEDERAL, HR 5546

– Internet

See INTERNET

– Predictive modeling and analytics to fight fraud, Special Report, 674

SOUTH CAROLINA

– Self-referrals, hospital violated Stark law, not FCA (D.S.C.), 335; new trial on FCA charges granted, 503

STANDING

– Billing for test not performed, suit dismissed (S.D. Ohio), 758

STARK LAWS

See generally SELF-REFERRALS

STATUTES OF LIMITATIONS

– Appeals, grant application, Eisenstein retroactivity (9th Cir.), 114; (U.S., rev den), 838
– Certification claims, Tenet Healthcare counsel charged (S.D. Fla.), 295; case time-barred, 382
– Hospitals, Brooklyn, false claims untimely filed (S.D.N.Y.), 252
– Immigration effect of guilty plea, motion to vacate untimely (E.D.N.Y.), 508
– Neb., limitations period extended, 347
– Physical therapists vs. clinic, service of process (D.N.J.), 125

SUBSTANCE ABUSE

– Counseling center owner indicted (N.J. Super. Ct.), 427
– Exclusion, doctor's challenge dismissed (S.D.W. Va.), 742
– Illegal distribution of controlled substances

– – Dentist sentenced for drug trafficking (Ky. Cir. Ct.), 37
– – Okla. doctor's conviction upheld (10th Cir.), 581
– – Osteopathic physician pleads guilty (W.D. Mo.), 662
– – Painkillers, doctor and wife convicted (D. Kan.), 580
– – Physician, sentence (S.D. Ill.), 294

– Internet pharmacies

– – Anxiety, insomnia, weight loss drugs, doctor sentenced (D.N.J.), 349
– – Discounted drugs, 23 firms, owner sentenced (N.D. Tex.), 33

– Methadone clinics, N.J. seeks $51.5M, 84
– Obtaining drugs by fraud, doctor arrested (D. Colo.), 753
– Outlook, 42
– Pain management doctors plead guilty to conspiracy (S.D. Tex.), 384
– Pharmacy technician charged with insurance fraud (E.D. Mo.), 430

SUPREME COURT, U.S.

– EMTALA, inpatient liability, Solicitor Gen. brief sought, 70; (rev den), 579
– False Claims Act

– – Appeals, grant application, Eisenstein retroactivity (rev den), 838
– – False certification alleged, dismissal for pleading failure upheld (rev sought), 848
– – Off-label use, Marinol whistleblower case dismissed (rev den), 552
– – Procrit kickbacks, original source disclosure (rev sought), 8; Solicitor Gen. view sought, 164; (rev den), 551
– – Qui tam suits based on state disclosures barred (rev and rem), 282

– “Honest-services” fraud law covers only bribery and kickbacks (aff, vac and rem), 550; implications of ruling, Insight, 594
– Marketing OxyContin, employment pact issue (rev sought), 740; (rev den), 837
– Nursing homes, patients' rights, suing for violations (rev sought), 32; (briefs filed), 118; (rev den), 167