Health Care Fraud

Since 1983 Hospice has been a Medicare benefit for individuals suffering with terminal conditions who have less than six months to live. In theory, the Medicare benefit allows patients to spend their last few months at home receiving comfort care until their death instead of enduring costly end-of-life care in a hospital setting. The program should have saved the government money while...

Healthcare fraud is rampant in the United States, costing the government billions of dollars each year. This type of fraud has deleterious effects on the average American taxpayer, causing healthcare costs to rise and fewer people to be able to get the healthcare they need. If you have first-hand knowledge of healthcare fraud, you can become a whistleblower to expose corruption in the...

The Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) established a national standard for the protection of certain health information. Specifically, the HIPAA Privacy Rule protects the privacy of individually identifiable health information, called protected health information (PHI).  Because healthcare fraud constitutes a major component of our practice...

The Stark Act, 42 USC Section 1395, includes a number of exceptions to the prohibition to the ownership and compensation arrangement described in my recent post. The evaluation and application of these exceptions can be a complex undertaking, thereby making a determination as to whether a particular arrangement is permitted by the Stark Law also complex.  The exceptions include Section...

What is the Stark Law? Congress enacted the Stark Law as part of the Omnibus Budget Reconciliation Act of 1989. The Stark Law, 42 USC Section 1395nn, also referred to as the Physician Self–Referral Law, has certain prohibitions when a physician or member of his or her immediate family has a direct or indirect financial arrangement or relationship with an entity: (1) First, the physician may...

The Federal Government and several major health insurers have recently announced a partnership that will take unprecedented steps to eviscerate fraud from the health care industry.  The two sides will share raw data, as well as investigative knowledge and expertise, as they aim to shut off billions of dollars in questionable payments made by the health care system each year. While...