Legal and practical healthcare information.
A summary of the article “A Review of Key 2018 False Claims Act Recoveries and Developments,” which first appeared in Physicians Practice. In December, the Department of Justice announced that it recovered more than $2.8 billion in False Claims Act judgments and settlements for fiscal year 2018. The largest settlements involved pharmaceutical companies: AmerisourceBergen Corporation, …
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Conflicts between a benefit plan Summary Plan Description and a plan document are an ever-present concern for plan sponsors. An aggrieved participant who relies on SPD language will often pursue a claim for benefits even though he/she is not entitled to the benefit under the plain terms of the plan document. This problem is illustrated …
Michigan, like the rest of the country, suffers from an opioid epidemic. Every day, more than 100 Americans die from an opioid overdose1. Some economists estimate that the opioid crisis has cost the U.S. economy more than $1 trillion since 2001 and is on pace to cost an additional $500 billion through 20202. The profligate …
Continue reading “Opioid Litigation Comes To Michigan – What Physicians And Hospitals Need To Know”
A 2017 Medscape survey indicated that over half of responding doctors had been sued for malpractice. The number one reason? Failure to diagnose a medical condition, given by 31% of respondents. Nearly half of doctors surveyed who were sued for malpractice spent between eleven and fifty hours in court, meetings with lawyers, or in other …
By: Kerry Harvey Corporations and individuals engaged in a heavily regulated industry, particularly those doing business with the federal government, stand a good chance of being called upon to provide information related to a government investigation. Healthcare providers, government contractors and financial institutions immediately come to mind. The initial contact may come in a number …
Continue reading “Department of Justice use of Parallel Proceedings”
By: Andrew Sparks Overpayments to healthcare providers receiving Medicare reimbursements are at risk of civil and criminal enforcement action if not attuned to a particular reimbursement rule and diligent in compliance with the rule’s requirements. In short, the overpayment rule turns potential billing mistakes into fraud. A healthcare provider cannot keep money paid in error. …
Continue reading “PREVENTING OVERPAYMENTS FROM BECOMING FALSE CLAIMS”
By: Denise H. Troy In Gullett v. Kindred Nursing Centers West, ___ Ariz. ___, 758 Ariz. Adv. Rep. 12 (App. 2017),the Arizona Court of Appeals ruled that an arbitration agreement between a patient and a convalescent hospital was enforceable over a challenge that it is was unfairly one-sided. Mr. Gullett signed an arbitration agreement at …
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By Timothy M. Cary New overtime regulations under the Fair Labor Standards Act set to go into effect on December 1, 2016, have been halted by a federal court in Texas. In State of Nevada v. U.S. Department of Labor, the court granted a preliminary injunction in favor of a group of twenty-one states who …
Continue reading “Nationwide Injunction Halts Department of Labor’s Overtime Expansion”
By Alexandra Hall & Jessica Russell The Mental Health Parity and Addiction Equity Act (Parity Act) requires health plans to provide the same coverage for mental health conditions as they provide for physical conditions, and that financial requirements and treatment limitations applicable to mental health and substance use disorder benefits be no more restrictive than …
Continue reading “Recent Developments in Mental Health Benefit Denials”
By Keith C. Dennen In Kellogg Brown & Root Services, Inc. v. United States ex rel. Carter, 575 U.S. ___) (2015), Justice Alito stated “[t]he False Claims Act’s qui tam provisions present many interpretive challenges.” Lawyers and judges who struggle with those challenges understand the truth of that statement. The United States Supreme Court recently …
Continue reading “Qui Tam Lawsuits and the Statute of Limitations”