20 results for 'cat:"Health Care" AND cat:"Medicare"'.
J. Dever grants a hospice care company’s motion to dismiss False Claims Act (FCA) allegations brought by a former home hospice case manager. The manager claims the company committed Medicare fraud by falsely reporting hospice patients’ medical conditions in order to recertify them. However, as this is a qui tam claim and other managers already initiated similar actions previously, the FCA’s first-to-file rule applies and the manager’s suit is barred.
Court: USDC Eastern District of North Carolina, Judge: Dever, Filed On: April 10, 2024, Case #: 7:20cv90, NOS: False Claims Act - Torts - Personal Injury, Categories: Fraud, health Care, medicare
J. Edwards upholds the district court's dismissal of a medical company's case challenging the Centers for Medicare and Medicaid Services' issuance of two technical letters instructing Medicare contractors to deny reimbursement for claims for products manufactured by the company. The agency has rescinded the letters. Affirmed.
Court: DC Circuit, Judge: Edwards, Filed On: February 16, 2024, Case #: 23-5020 , Categories: Administrative Law, health Care, medicare
J. Gaughan denies the government's motion to dismiss, ruling that even if the health care provider did not fully exhaust its administrative remedies prior to filing suit to challenge calculation methods used to determine its Medicare overpayment, administrative exhaustion is not a jurisdictional requirement of the statute. Furthermore, any appeals process would have been futile, given the calculation methods could not be challenged before the administrative law judge.
Court: USDC Northern District of Ohio, Judge: Gaughan, Filed On: December 1, 2023, Case #: 1:23cv859, NOS: Other Statutory Actions - Other Suits, Categories: health Care, Jurisdiction, medicare
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J. Kollar-Kotelly finds, in part, for a group of hospitals on their appeal of the Provider Reimbursement Review Board's dismissal of their administrative appeal challenging the Medicare compensation they received. Contrary to the board's determination, it had jurisdiction over their appeal, as the Centers for Medicare & Medicaid Services' publications are considered final determinations.
Court: USDC District of Columbia, Judge: Kollar-Kotelly, Filed On: October 31, 2023, Case #: 1:17cv545, NOS: Medicare Act - Contract, Categories: Administrative Law, health Care, medicare
J. Murguia finds that a matter is to be reheard and vacates a previous order. The matter involves a near-absolute ban on abortion in the state of Idaho, but under federal law hospitals that receive Medicare funds are required to provide abortions for emergencies that include ectopic pregnancy, severe preeclampsia, a septic infection or hemorrhage.
Court: 9th Circuit, Judge: Murguia, Filed On: October 10, 2023, Case #: 23-35440, Categories: health Care, medicare
J. Saylor grants in part a pharmaceutical company’s motion for summary judgment against the federal government, who is suing it for allegedly funneling money meant for charitable purposes into increasing sales of its own drug. The government provided enough facts to support that the company violated the Anti-Kickback Statute to withstand summary judgment, but did not sufficiently provide evidence to support that the company is guilty of unjust enrichment.
Court: USDC Massachusetts, Judge: Saylor, Filed On: September 27, 2023, Case #: 1:20cv11217, NOS: False Claims Act - Torts - Personal Injury, Categories: health Care, Business Practices, medicare
J. Bush finds the lower court's decision to grant the Department of Health and Human Services' motion for summary judgment on the child's Medicare claim was supported by sufficient and credible evidence, including testimony that she did not use a prosthetic device to consume Vitaflo Homocystinuria coolers for treatment of her homocystinuria, a prerequisite under Medicare. Although the patient's liver cannot process certain types of amino acids because of her condition, she does not require a feeding tube or pump that would qualify her for coverage. Affirmed.
Court: 6th Circuit, Judge: Bush, Filed On: September 11, 2023, Case #: 22-1997, Categories: Evidence, health Care, medicare
J. Gershon dismisses a False Claims Act whistleblower complaint brought against an oncology clinic for allegedly charging Medicare for overfill oncology medications. The litigant, a healthcare provider, fails to allege its principal had firsthand knowledge of the defendant’s actions or conducted a thorough investigation to corroborate claims made by other sources. As well, it fails to show that the defendant voluntarily disclosed relevant information to the U.S. government, a requirement under the law.
Court: USDC Eastern District of New York, Judge: Gershon, Filed On: September 8, 2023, Case #: 1:19cv5125, NOS: False Claims Act - Torts - Personal Injury, Categories: health Care, medicare, False Claims
J. Katsas finds the district court properly found for the Secretary of Health and Human Services on 200 hospitals action seeking additional Medicare-related reimbursements. Additional reimbursements are paid only for patients receiving cash payments for supplemental security income benefits, not patients receiving a subsidy under Medicare Part D and vocational training. Affirmed.
Court: DC Circuit, Judge: Katsas, Filed On: September 1, 2023, Case #: 22-5214, Categories: health Care, medicare
J. Katsas upholds the district court's decision to set aside a review board's determination that a hospital failed to prove an undercount of its Medicare patients who were entitled to social security income benefits, which in turn, would have entitled the hospital to greater Medicare reimbursements. The hospital provided evidence to support its undercount claim, to which the Department of Health and Human Services did not respond. Affirmed.
Court: DC Circuit, Judge: Katsas, Filed On: September 1, 2023, Case #: 20-5350 , Categories: Administrative Law, health Care, medicare
J. Gorton denies a pharmaceutical company’s motion for summary judgment and grants the federal government’s motion for partial summary judgment in a case against the pharmaceutical firm for allegedly paying kickbacks for false Medicare claims through illegal copay subsidies on Copaxone, a drug for multiple sclerosis. There are emails from the drug maker’s employees that show its employees believe that the company would have lost Copaxone sales if it didn’t offer the subsidies. Anti-kickback statute violations that result in federal health care payments are automatically considered false claims under the False Claims Act.
Court: USDC Massachusetts, Judge: Gorton, Filed On: July 14, 2023, Case #: 1:20cv11548, NOS: False Claims Act - Torts - Personal Injury, Categories: health Care, medicare, False Claims
Per curiam, the Fifth Circuit finds the tax court properly found the temporary hospital administrator liable for trust fund recovery penalties. After the chief administrator was indicted for a scheme to defraud Medicare, the temp administrator was directed to serve. Regardless of other conflicting duties, or her resignation caused by the “toxic” working environment, she did become aware of the growing tax liability and had a duty to ensure that taxes were paid before authorizing payments to vendors or employees. She authorized checks to pay staff, utilities and vendors despite being aware that withholding taxes were due and the reasonable cause defense does not apply. Affirmed.
Court: 5th Circuit, Judge: Per curiam, Filed On: May 31, 2023, Case #: 22-60024, Categories: health Care, Tax, medicare
J. Brinkema grants the government's motion for summary judgment in a False Claims Act suit. The medical company, accused of lying to Medicare to receive extra reimbursements, failed to file an answer nor request additional time to retain counsel.
Court: USDC Eastern District of Virginia, Judge: Brinkema, Filed On: May 26, 2023, Case #: 1:22cv965, NOS: False Claims Act - Torts - Personal Injury, Categories: health Care, medicare, False Claims
[Consolidated]. J. Benton finds a lower court properly convicted two doctors for healthcare fraud and conspiracy to commit crimes against the government. The doctors argued that they were entitled to acquittal based on lack of evidence. However, the government presented sufficient evidence in court that the doctors injected their pain clinics patients with a non-FDA approved drug called Orthovisc, even though their own employees cautioned them otherwise. Affirmed.
Court: 8th Circuit, Judge: Benton, Filed On: May 18, 2023, Case #: 22-28864, Categories: Fraud, health Care, medicare