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Showing 12 posts in Health Care.

Sixth Circuit Applies Escobar Ruling in Decision to Resuscitate False Claims Act Case

The United States Court of Appeals for the Sixth Circuit recently resuscitated a qui tam action under the False Claims Act (FCA), and, in so doing, held that the relator had properly alleged materiality under the U.S. Supreme Court's decision in Universal Health Services Inc. v. United States ex rel. Escobar, 136 S. Ct. 1989, 2002 (2016). The Sixth Circuit's decision, U.S. ex rel. Prather v. Brookdale Senior Living Communities, Inc., 892 F.3d 22 (6th Cir. June 11, 2018) addressed a relator's claims under the FCA. The FCA imposes civil liability on those who defraud the federal government by levying fines and penalties, including up to three times the government's damages. Private persons called relators file lawsuits or qui tam actions for violations of the FCA on behalf of the government. More ›

More than 600 Healthcare Professionals Hit by DOJ with Medicare Fraud Charges

The number of criminal charges filed annually by the Department of Justice (DOJ) against health care providers and professionals continues to escalate. On June 28, 2018, the DOJ announced that the Medicare Fraud Strike Force had charged 601 individuals across the United States, including more than 150 physicians, nurses, and other licensed medical professionals for participating in health care fraud schemes involving more than $2 billion in false billings this summer. At the same time, the U.S. Department of Health and Human Services initiated suspension actions against numerous providers, including doctors, nurses, and pharmacists. More ›

NLRB Evaluation of Personnel Handbook Finds Moonlighting Policy Unlawful

Health care employers should take note of a recent decision of an Administrative Law Judge (ALJ) of the National Labor Relations Board (NLRB) which struck down a number of employer policies in a Personnel Handbook, including a limitation on anti-moonlighting. Anti-moonlighting provisions are common in health care provider contracts and in personnel manuals of health care providers, including group practices, hospitals and other larger health care employers. The reasons for such rules in the health care setting are straightforward and largely non-controversial. They include the fact that risk to patients go up if employees are fatigued at work. Health care providers also may require varying shifts or mandatory overtime. Such rules minimize workplace conflict when employees are unable to satisfy the staffing requirements of their primary employer because of a second job commitment. Obviously, working for a competitor provider is also something that most group practices, hospitals and other providers, seek to limit. More ›

Illinois Appeals Court Protects Hospital Counsel's Right to Speak with Former Agents of Hospital

For attorneys who represent hospitals in medical malpractice cases, dealing with nursing witnesses who have retired or relocated can be difficult. In addition to the practical issues of finding these witnesses, contacting them and communicating with them remotely, potential legal issues can further complicate circumstances. For example, opposing counsel may take issue with attempts to contact such witnesses under the broad prohibition against defense attorneys communicating with treating witnesses (known as the Petrillo doctrine). Opposing counsel may also seek the exact nature and content of such communication and challenge the existence of any privilege protecting it. While in most cases these issues can be resolved informally among the attorneys, hospital attorneys should keep the case of Caldwell vs. Advocate Condell Medical Center, 2017 IL App (2d) 160456 (Oct. 4, 2017) at ready reference in case they cannot. More ›

Common Mistakes Physician Extenders Make in Their Practices

First of all, for those who may be thinking “what is a physician extender,” a physician extender is a licensed health care provider (not a physician) that provides medical services typically performed by a physician. More ›

EMR and E-Discovery Part Five: On Standard of Care and Final Thoughts

In the final installment of our series, EMR and E-Discovery, author David Levitt discusses the need for healthcare institutions to develop a management strategy for patient care communications and its impact on standard of care. More ›

EMR and E-Discovery Part Four: Reading Complexities

In part four of our series, EMR and E-Discovery, author David Levitt unpacks the difficulties associated with reading EMR in its native state and the additional complexities that accompany counsel's ability to access EMR, which is only produced in PDF form. More ›

411 on Telehealth

The world of health care delivery is quickly evolving to meet both personalized consumer demand and the need for cost-efficient, quality outcomes. More ›

Healthcare Providers Beware: Medicare Billing Can Be Risky Business

When a health care provider or third party billing service submits a claim for services rendered to a Medicare patient, it’s filing a bill with the government that certifies the payment was earned and complies with certain billing requirements. More ›

EMR and E-Discovery Part Three: All Systems Go

In part three of our series, EMR and E-Discovery, author David Levitt details the current diagnostic tools utilized by modern health care as well as some of the considerations healthcare institutions should evaluate when making decisions about software and licensing. More ›

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