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The Baxter Settlement and its Implications for FCA Liability
Kaitlin Lavin Executive Editor Loyola University Chicago School of Law, JD 2017 In January, Baxter Healthcare Corporation (“Baxter”) agreed to pay $18,158 million after the Department of Justice (DOJ) brought suit for violating the Food, Drug, and Cosmetic Act (FCDA) and the False Claims Act (FCA). The Baxter case is unique because it was …
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Finalized Rule: Tough Love for Medicaid MCOs?
Kaitlin Lavin Executive Editor Loyola University Chicago School of Law, JD 2017 Last May, the Centers for Medicare and Medicaid Services (CMS) issued a final rule for Medicaid managed care, which told states to stop making pass-through payments to healthcare providers. Pass-through payments have played a critical role in funding safety net hospitals which …
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Mylan Medicaid Fraud Investigations
Kaitlin Lavin Executive Editor Loyola University Chicago School of Law, JD 2017 Mylan has already been under public scrutiny for increasing the price of its EpiPen allergy shots. Last week the State of West Virginia launched a Medicaid fraud investigation questioning Mylan’s price hike and compliance with drug rebate laws. Mylan Pharmaceuticals participates in …
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CMS Issues Proposed Rule Addressing Multiple Fraud and Abuse Concerns
Kaitlin Lavin Executive Editor Loyola University Chicago School of Law, JD 2017 The Centers for Medicare and Medicaid Services (CMS) recently proposed a new rule in the Federal Register that addresses changes in Medicare payment policies. The proposed rule aims to inform providers of proper billing practices and prevent fraud and abuse. This post …
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Medicare Advantage Audits Reveal Alleged Rampant Upcoding
Kaitlin Lavin Executive Editor Loyola University Chicago School of Law, JD 2017 Last month, the Center for Public Integrity obtained over three-dozen new Medicare Advantage (MA) audits through a lawsuit brought under the Freedom of Information Act. The audits indicate that overcharging is still a pervasive problem in the MA Program because Medicare Advantage …
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Another Suit against Vanguard Healthcare
Kaitlin Lavin Executive Editor Loyola University Chicago School of Law, JD 2017 In 2011, Vanguard Healthcare, LLC (“Vanguard”) settled a whistleblower suit for Medicare and Medicaid fraud and entered into a Corporate Integrity Agreement (CIA). Now the federal government is suing Vanguard for submitting fraudulent claims for services that were “either non-existent or grossly …
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Big Pharma Scorecard Encouraging Greater Clinical Trial Transparency
Kaitlin Lavin Executive Editor Loyola University Chicago School of Law, JD 2017 Bioethics International (BEI), a non-profit organization, is working to improve transparency and ethics in healthcare delivery and innovation by holding pharmaceutical companies accountable for compliance with the Food and Drug Administration Amendments Act (FDAAA). Many people do not trust drug companies, believing …
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Cybersecurity Biggest Risk to Financial System, Regulators Plan to Provide More Oversight
Kaitlin Lavin Executive Editor Loyola University Chicago School of Law, JD 2017 Financial institutions can expect increased oversight and new regulations due to recent cyberattacks and data breaches in banks. Several banks have already reported data breaches this year, and many banks have been rattled by the cyberattacks on SWIFT—the messaging network connecting the …
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The New Medicaid Managed Care Rule and Its Effects on Compliance Programs
Kaitlin Lavin Executive Editor Loyola University Chicago School of Law, JD 2017 The Centers for Medicare and Medicaid Services (CMS) recently published a new rule for state contracts with Medicaid Managed Care Organizations (MCO). Medicaid MCOs provide comprehensive services to beneficiaries for capitated payments. The effective date of the rule was July 5, 2016. …
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