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The Firm successfully defended the Firm’s nurse practitioner client against allegations that the nurse practitioner had submitted false claims to the Medicaid Program in connection with medical and diagnostic services provided at the client’s medical clinic.  After a lengthy investigation, the Medicaid Fraud Control Unit closed the investigation with no action being taken against the Read more →

Tags : case closed , fraud investigation , Medicaid

In connection with the Firm’s defense of a Department of Defense procurement fraud investigation concerning the sale of confidential government contract information, the Firm was able to negotiate a resolution of the case to a misdemeanor plea with a $1,000 fine.  As anyone who practices in the area of Federal Criminal defense can attest, misdemeanor Read more →

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On October 13, 2017, the Department of Justice announced a False Claims Act settlement with First Coast Cardiovascular Institute, a Florida based health clinic, under which the practice will pay $448,821.58 for failing to timely refund $175,000 in overpayments to Medicare, Medicaid, TRICARE, and the Department of Veterans Affairs. The settlement is noteworthy because it Read more →

Tags : False Claims Act

In a 2-1 Decision, the D.C. Circuit Court of Appeals reversed the district court’s order to HHS to clear the backlog of administrative appeals within four years. The appellate court found that the district court failed to adequately test HHS’s assertion that this mandate was impossible. After considering the merits of a group of hospitals Read more →

Tags : Medicare Claims

On August 14, 2017, CMS announced a significant change in its claims audit strategy for Medicare Administrative Contractors (MACs).  Under the new strategy — called Targeted Probe and Educate — MACs “will select claims for items/services that pose the greatest financial risk to the Medicare trust fund and/or those that have a high national error rate.”  Read more →

Tags : MACs , Medicare Audit , Medicare Claims