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Health Care Fraud Report™

Product Code: HFLN21
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What this service is:

A complete yet concise synthesis of one of today's fastest growing legal specialties, the Health Care Fraud Report monitors a broad range of health care fraud and abuse issues in the private insurance industry, managed care organizations, and federal and state programs.

What it helps you do:

  • Protect your company or clients with inside information on a variety of current fraud and abuse topics, complete with expert analysis.
  • Reduce your risks by staying up-to-date on pertinent legislative, regulatory, and legal developments at federal and state levels. Be aware of policy changes in the private sector.
  • Prepare to face increased scrutiny from federal agencies charged with enforcement of anti-fraud measures, as well as from whistleblowers.
  • Learn how to prevent and detect fraud where you work, and how to report suspected fraud to the government.
  • Follow federal health care anti-fraud initiatives and enforcement efforts at the Centers for Medicare & Medicaid Services, Health and Human Services Office of Inspector General, FBI, Department of Justice, and other government agencies.
  • Understand the civil and criminal health care fraud provisions and the changes to False Claims Act enforcement under the Patient Protection and Affordable Care Act.
  • Save valuable reading and research time. Track federal and state legislation and hearings, legal decisions and settlements, conferences and meetings, and health care association activities.
  • Gain insights from analysis and perspective pieces by recognized experts and other special reports.
  • Have significant documents in full text at your fingertips. Consult original language to form your own interpretations.
  • Get the right amount of data and detail on health care fraud and abuse in just one manageable, well-organized source.
Product Structure 

Notification: current reports providing news and developments

Formats and Frequency

Print and Web notification formats are issued and available biweekly. Print current reports are indexed every six months, cumulating annually. Web current reports are archived to 1/15/1997. E-mail summaries, providing the highlights and table of contents for each report, with URLs to full-text articles and documents are also available.

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  • Anti-kickback
  • Billing
  • Civil and criminal penalties
  • Claims processing
  • Clinical laboratories
  • Contractor fraud
  • Elder abuse
  • Embezzlement
  • False Claims Act
  • Home health
  • Hospitals
  • Hotlines
  • Internet fraud
  • Investigations
  • Managed care
  • Medicare/Medicaid
  • Medical errors
  • Nursing homes
  • Overpayments
  • Patient dumping
  • Pharmaceuticals
  • Quality of care
  • Research fraud
  • Stark Law compliance
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July 23, 2014
  • Senate Report Recommends Changing RAC Payment Structure, Streamlining Contractors
  • Medicare Paid $1.7 Billion in Questionable Clinical Lab Claims in 2010, OIG Report Says
  • Industry Stakeholders Oppose OIG Efforts to Expand Exclusion Authority
  • OIG: Limited Submission of Medicaid Data Contributed to Improper Payments
  • DOJ, HHS Release ‘Road Map' Against Elder Abuse, Legal Training Guides
  • Dignity Health Pays $1.55M to Resolve Mishandling of Controlled Substances
  • Federal Audit Finds Florida Paid For Drugs Prescribed by Excluded Providers
  • Hospital Group Files for Summary Judgment Against HHS Over Medicare Appeals Backlog
  • Halifax Hospital to Settle Remaining FCA Claims With Whistle-Blower for $1M
  • Four Patient Recruiters Plead Guilty In $20 Million Home Health Fraud
  • Florida Man Sentenced to Four Years In $10.5 Million Physical Therapy Scam
  • Medtronic Pays $2.8 Million to Settle Allegations Involving Infusion Pumps
  • FCA Action Against Billing Company, Dentist Dismissed on Pleading Deficiencies
  • Defendants Get New Trial on Conspiracy Charges for Delay in Turning Over Evidence
  • U.S. Intervenes in FCA Action Against Hospitals Over Medicaid Overpayments
  • MAC Denial of Power Wheelchair Coverage Reversed, Decision Unsupported by Evidence
  • Whistle-Blower Action Against Dermatology Practice Over Medicare Billings Dismissed
  • FCA Action Against Mental Health Clinic Dismissed for Repeated Pleading Defects
  • Government FCA Action Against Nursing Home to Continue
  • OMHA Chief Judge: More Funds Needed To Eliminate Medicare Appeals Backlog
  • FedEx Indicted for Shipping Drugs for Illegal Pharmacies
  • Operators of Illinois Home Health Agency Indicted on Medicare Fraud Charges
  • California Man Sentenced to 10 Years For Medicare Fraud, Identity Theft
  • Alabama Health-Care Providers Settle False Claims Case for $24.5 Million
  • Doctor Admits to Accepting Bribes For Referring Tests to New Jersey Lab
  • Pharmacist Sentenced to 37 Months, Fined $1 Million for Illegal Narcotics Sales
  • Conn. Doctor Charged With Exceeding Scope Of License to Dispense Controlled Substances
  • X-Ray Company Executive Pleads Guilty to Health-Care Fraud Scheme
  • ALJ Upholds Supplier's 10-Year Exclusion Based on Fraud and Conspiracy Conviction
  • New Massachusetts Law Prohibits Physician Self Referral to Clinical Labs
  • Indian Generic Drugmaker Ranbaxy Settles Fraud Allegations With Oregon AG
  • Long-Term Care Insurer Can Sue Insured, Domestic Partner for Fraud and Conspiracy
  • Grand Jury Indicts Three Californians For $50 Million Insurance Fraud Scheme
  • List of HHS OIG Audit and Inspection Reports
  • HHS OIG Program Exclusions
  • CONFERENCES
July 09, 2014
  • U.S. Supreme Court Will Address FCA's First-to-File Bar, Wartime Claim Tolling Rule
  • OIG Says Lab Processing and Registry Arrangements May Violate Anti-Kickback Law
  • ACA Insurance Marketplaces Failed to Fix Inconsistencies in Applicants' Data, OIG Says
  • OIG Finds Pennsylvania Complied with ACA ‘Credible Allegations of Fraud' Requirements
  • Seattle Hospital Owes Almost $1 Million In Medicare Overpayments, OIG Audit Finds
  • Calif. Improperly Claimed Reimbursement For Some Nonemergency Patient Transports
  • Backlash Against RACs May Be Near Tipping Point, Congressional Aide Says
  • Proposed Hospital Outpatient Pay Rule Adds Measures to Boost Overpayment Collections
  • Physician Pay Rule Would Remove Some Sunshine Act Reporting Exemptions for CME
  • Lawmakers Grill Officials Over Medicare Program Integrity Lapses, Call for Action
  • SEC Seeks Documents From Biomet Related to Company's Overseas Operations
  • Consumer Group Urges Joint Commission Investigation of Firm's Accreditation Claims
  • Drug Distributor Settles for Failure To Report Suspicious Oxycodone Orders
  • Medically Unnecessary Cardiac Procedures Among Fraud Hot Spots, OIG Official Says
  • Patient Education Pivotal to Fixing Health-Care System, Senator Says
  • CMS Official Says Three Studies Completed By Healthcare Fraud Prevention Partnership
  • Study Examines Cost Differences in Employer, Government Health Costs for Impact of ACA
  • No Evidence of Medicare Upcoding Amid Fears, Growth in EHRs, Study Says
  • Health, Business Groups Lobby Supreme Court on FCA Penalties
  • Omnicare Will Pay $124M to Settle Kickback Allegations, DOJ Says
  • DME Supplier Can Sue Government For Breach of Medicare Contract
  • Federal Claims Court Says Government Breached Contract With Equipment Supplier
  • Medicare to Postpone Awarding Three RAC Contracts Until Aug. 15, Court Says
  • Court Says Details of Upcoding Incidents Clear FCA's Rule 9(b) Bar
  • Former HIV Clinic Owner Pleads Guilty To $31 Million Medicare Fraud Scheme
  • Physician Pleads Guilty to Role In $7M Detroit-Area Medicare Fraud Scheme
  • Doctor Pleads Guilty to Criminal Charges, Will Pay $6M to Settle Civil Fraud Allegations
  • Recruiter Pleads Guilty in $6.5 Million Home Health Medicare Scam in Florida
  • U.S. Attorney Says Doctor's Estate Will Repay $4M in Medicare Case
  • Prison, $16.2M Restitution Ordered For Hospice Owner in Medicare Scam
  • Court Rejects Hospital's Timeliness Defense In Suit Alleging Patients Improperly Admitted
  • Philadelphia-Area Ambulance Company, Owners Charged With Bilking Medicare
  • Pennsylvania Ambulance Company Manager Gets Prison Term in Health-Care Fraud Case
  • Court Refuses to Dismiss Charges Alleging Physicians Accepted Kickbacks
  • Federal Court Orders Par Pharmaceutical To File Answers in Unlawful Marketing Action
  • Court Dismisses Whistleblower's Lawsuit Alleging Error-Ridden Claims Violated FCA
  • Prison, Restitution Ordered for Owner Of Ambulance Firm in Medicare Fraud Case
  • First-to-File Rule Means Only One Relator Shares in Qui Tam Proceeds
  • Guilty Pleas Entered in Unapproved Drug Case Involving Kentucky Clinic
  • Suit Alleging Hospitals Paid Clinics to Refer Undocumented Mothers for Delivery Proceeds
  • Indictment Alleges Nursing Home Operators Billed Medicare, Medicaid for Deficient Care
  • Fourth Circuit Upholds Fraud Conviction Of Rescue Squad Chief Falsifying Statements
  • Physician Involved in Cash-for-Referrals Scheme With Lab Sentenced to Two Years
  • Maryland Pain Doctors Indicted on Fraud Charges
  • State Medicaid Program Should Collect Provider Overpayments, Audit Says
  • N.Y. Attorney General Files FCA Suit Against Three Health Systems
  • Medicaid IG Releases Compliance Guide On Common Risks in Habilitation Settings
  • Georgia Man Gets Two-Year Sentence In Speech Therapy Medicaid Fraud
  • New Law Requires Health Providers, Others To Report Suspected Elder Abuse as of July 1
  • Three More Sentenced in Georgia Youth Counseling Center Medicaid Scam
  • Listing
  • List of HHS OIG Audit and Inspection Reports
  • Changing Tactics at the DOJ Stand to Permanently Alter the Face of Qui Tam Litigation
  • Top 10 RAC Mistakes and How to Avoid Them: Centralizing Your RAC and Audit Processes Smooths Workflow
  • CONFERENCES
June 25, 2014
  • Supreme Court Grants Review in APA Case With Potential Implications for Providers
  • CMS Seeks Comments on Disclosure Rule For Referring Patients for Ancillary Services
  • CMS Imposes About $1 Million in Penalties Among Six Private Medicare Part C, D Plans
  • New ICD-10 Compliance Date Could Be Released Soon in Final CMS Rule
  • House Panel Approves Bills On Rx Drug Abuse, Timely DEA Scheduling
  • Senate Finance Committee Leaders Seek Ideas to Improve Data Transparency
  • CMS Should Increase Efforts Against Improper Medicaid Managed Care Payments
  • AMA Objects to CMS Medicare Claims Data Releases; Calls Process ‘Misleading’
  • AMA Calls for Providing New Mechanisms On Pricing Strategies for Medical Services
  • OIG Determines Market Shares for Mailed Diabetes Test Strips for Competitive Bidding
  • Ten Suppliers Account for Large Amount Of Medicare Market Share, Report Finds
  • Inconsistent Definitions Cost Medicare Over $1 Million for Confined Beneficiaries
  • Ohio Hospital Owes $9.8 Million In Medicare Overpayments, Audit Finds
  • Senior Medicare Patrol Lead to $9 Million In Medicare, Medicaid Recoveries in 2013
  • HHS Reports Data Breach, HIPAA Rule Enforcement Trends to Congress
  • Attorneys Outline Requirements Of Sunshine Act for Hospitals and Doctors
  • Consultant Warns of New DOL Audits On Compliance With Main Parts of ACA
  • Jury Orders Clinical Testing Lab Millennium To Pay $14.7 Million to Competitor Ameritox
  • 5th Cir. Affirms Dismissal of FCA Action Against Planned Parenthood Location
  • 11th Cir. Upholds Nursing Home Operator's Conviction for ‘Worthless’ Services
  • Supreme Court Denies Whistle-Blowers Last Chance at $38M Fraud Award
  • Home Care and Hospice Group Sues To Block CMS Documentation Rule
  • Government Gets Partial Victory In Fraud Case Against Home Health Provider
  • Woman Pleads Guilty to Kickbacks In $7 Million Medicare Fraud Case
  • Florida Doctor Gets Prison Term In $2.5 Million Fraud, Pain Pill Case
  • Florida Man Sentenced to 27 Months For Bogus Outpatient Medicare Scheme
  • Patient Recruiter Involved in $205M Mental Health Scheme Pleads Guilty
  • Home Health Agency Owner in Miami Pleads Guilty in $6.5 Million Fraud Case
  • Former Owners of DME Shops, Recruiter Sentenced in $3.2 Million Wheelchair Scam
  • Court Quashes Subpoenas Seeking Files From Whistle-Blower's Prior FCA Actions
  • Hospice Denied Repayment Reprieve On Overpayments a Second Time
  • Advocacy Group Says Due Process Rights Violated by Appeals Denials
  • Government Intervenes in FCA Action Against Hospitalist Company for Upcoding Scheme
  • Medicare Contractor's Overpayment Extrapolation Upheld Over Expert's Objections
  • Former Ambulance Company Owner Gets Eight Years for Medicare Fraud Scheme
  • Drug Supplier Omnicare Must Face Whistle-Blower's FCA, Kickback Claims
  • Jury Convicts DME Owner for Involvement In Multi-Million Dollar Wire Fraud Scheme
  • Doctor Convicted in Cash-for-Patients Scheme Sentenced to 20 Months in Prison
  • Owners of Mobile Diagnostic Testing Business Charged With Defrauding Medicare
  • Power Air Mattress Saleswoman Admits To Falsifying Patient Skin Condition Reports
  • Illinois Businessman Pleads Guilty In Misbranded Botox, Juvederm Case
  • Tennessee Cancer Clinic Owners Fined, Receive Probation Over Misbranded Drugs
  • ALJ Affirms Five-Year Exclusion Based on Drug-Related Felony
  • ALJ Upholds $3,500 Penalty for Failure To Train Staff to Evacuate Obese Resident
  • Chiropractor Pleads Guilty to Destroying Records
  • FCA ‘Implied False Certification' Liability Rejected
  • GSK to Pay West Virginia $22M to Resolve Allegations of Improper Drug Marketing
  • Pennsylvania Supreme Court Throws Out Money Award to BMS in Drug Pricing Case
  • State Arrests 13 in Connection With Alleged New Jersey Imaging Center Kickback Scheme
  • State University to Repay New York For Excess Medicaid Dental Billings
  • New York State Legislature Approves Whistleblower Protections for Employees
  • Noncompliance With Criminal Screening Rule Isn't Violation of N.M. Medicaid Fraud Act
  • Pharmacy Chains Win Dismissal of Medicaid Fraud Claims in Michigan Supreme Court
  • Georgia Youth Counseling Provider Faces Seven Years in Jail for Medicaid Fraud
  • Small Chain of Nursing Homes, CEO To Pay $750,000 to Settle Poor Care Probe
  • HHS Anti-Fraud Award Goes to Va. Enforcement Unit
  • Listing
  • List of HHS OIG Audit and Inspection Reports
  • Impending Qui Tams and False Claims Act Cases Involving Health Exchanges
  • CONFERENCES
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