Medicare Compliance & Reimbursement
WHISTLEBLOWER WINDFALL IN RECORD-BREAKING STARK CASE
A hospital employee who blew the whistle on alleged stark violations in a hospital-physician practice lease deal will collect a big chunk of the settlement proceeds - and those proceeds represent the biggest Stark settlement ever. Rapid City Regional Hospital and Oncology Associates agreed to pay about $6.5 million to settle the qui tam action, which was initially brought by former RCRH employee Karen Johnson-Pochardt. The Department of Justice maintained that Johnson-Pochardt ought to get 16 percent of the proceeds for her role as qui tam relator - but a federal judge Feb. 26 ordered that she collect much more. U.S. District Judge Karen Schreier pointed out that Johnson-Pochardt did virtually everything the DOJ expects from a whistleblower. Schreier noted that Johnson Pochardt identified - and carefully documented - an alleged fraud the government otherwise never would have found out about. The judge emphasized - and this merits careful attention from health care providers - that she also reported the problem to her superiors, and made extensive efforts to get the problem resolved internally before turning to the feds. As a result, Schreier ruled in U.S. ex rel Johnson-Pochardt v. Rapid City Regional Hospital (No. CIV 2001-5019) that Johnson-Pochardt should collect 24 percent of the settlement trove, just one percentage point below the statutory maximum. In the ruling, Schreier emphasized that Johnson-Pochardt's work on the whistleblower case came at considerable personal sacrifice. She'll now be a millionaire. Lesson Learned: Health care leaders should listen - and take prompt action - when employees come to them with compliance concerns. Failure to do so can cost an organization big. To see Judge Schreier's decision, go to http://www.sdbar.org/opinions/DSD/2003/2003dsd003.htm.
Medicare Compliance & Reimbursement
- Budget:
SENATORS, PROVIDERS ARGUE AGAINST MEDICAID CUTS
Seventy-nine senators, led by Finance Committee chair Chuck Grassley (R-IA) and senior panel Democrat Max [...] - Reimbursement:
ROCKY REIMBURSEMENT ROAD AHEAD FOR PHYSICIANS, HOSPITALS
Physicians aren't getting much opportunity to celebrate this year's Medicare reimbursement increase. At a March [...] - HIPAA:
OCR OPENS DOOR TO PRIVACY COMPLAINTS
Health care organizations, take note: The HHS Office of Civil Rights March 20 laid out [...] - Home Health:
HOME HEALTH INDUSTRY GRAPPLES WITH SPENDING GROWTH FIGURES
Home care providers' efforts to secure reimbursement relief from Congress may have taken a hit [...] - DME:
FEDS MEAN BUSINESS ON TELEMARKETING RESTRICTIONS
Federal regulators are walking their talk when it comes to enforcing rules prohibiting durable medical [...] - Ambulances:
MEDICAL NECESSITY KEY IN AMBULANCE COMPLIANCE GUIDANCE
As health care fraud enforcement heats up for ambulance suppliers - especially at the state [...] - Hospitals:
WHISTLEBLOWER WINDFALL IN RECORD-BREAKING STARK CASE
A hospital employee who blew the whistle on alleged stark violations in a hospital-physician practice [...] - Hospitals:
CHARITABLE PROGRAMS CAN EVADE KICKBACK PERILS
Hospitals with a charitable mission have to take care that their efforts to help indigent [...] - DME:
DON'T BE TOO FORWARD WITH YOUR ADVANCES, OIG TELLS DMERCs
The check may be in the mail - but you might never see it anyway. [...] - Fraud & Abuse:
PAY A FINE, APPEAR ONLINE
Clash with the HHS Office of Inspector General and you could find yourself touted on [...] - Managed Care:
DUAL-ELIGIBLE BLUNDERS COMPLICATE MCO PAYMENTS
Florida managed Medicare companies were the lucky beneficiaries of a costly error by the Florida [...] - ASCs:
ASC RATESETTING STILL STALLED
Ambulatory surgical centers now have an updated list of the procedures Medicare has approved for [...] - Medicaid:
SUPREME COURT WILL HEAR TEXAS MEDICAID CASE
Did Texas waive its immunity under the federal constitution's 11th Amendment by entering into a [...] - BILL WATCH
The following House bill was introduced: H.R. 1422. A bill to amend title XVIII of [...] - REGISTER WATCH
Haven't been keeping up with the Federal Register? Missing a back issue? Here's your chance [...] - PROGRAM MEMO ROUNDUP
Medicare carriers will continue using existing policies on using statistical sampling to estimate provider overpayments, [...]
