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DOJ Joins Whistleblower Suit Against UnitedHealth Group
The United States Department of Justice (“DOJ”) recently intervened in a qui tam action against UnitedHealth Group (“United”) and its subsidiary, UnitedHealthcare Medicare & Retirement, the nation’s largest provider of Medicare Advantage (“MA”) Plans. The suit alleges that United engaged in an “up-coding” scheme to receive higher payments than they should have under MA’s risk adjustment program. Assuming these allegations of United’s false claims are true, then United billed and received hundreds of millions of dollars in improper payments from Medicare.
HHS Finalizes Substance Abuse Patient Record Sharing Rule
Fannie Fang Executive Editor Loyola University Chicago School of Law, JD 2017 On January 18, 2017, the Department of Health and Human Services (“HHS”) issued a final rule to update and improve the Confidentiality of Alcohol and Drug Abuse Patient Records regulations, known as 42 CFR Part 2 (“Part 2”). The purpose of the …
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New Era of Healthcare Fraud Investigations Focuses On Individual Accountability
Fannie Fang Executive Editor Loyola University Chicago School of Law, JD 2017 Traditionally, only healthcare corporations were held responsible for healthcare fraud. During an investigation, these corporations were only required to provide contextual information about the underlying factual situation in a fraud investigation. Additionally, healthcare corporations would typically enter into settlement agreements with the …
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How Communications Play a Key Role in the Hospital Readmissions Reduction
Fannie Fang Executive Editor Loyola University Chicago School of Law, JD 2017 CMS has reported that Medicare expenditures amount to roughly 17 billion a year on patient readmissions alone. Studies show that almost twenty percent of all patients who are admitted to a U.S. hospital makes a repeat visit within thirty days of discharge. …
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Advocate Settles with OCR for $5.55 Million, Officially the Highest Single HIPAA Violation Settlement to Date
Fannie Fang Executive Editor Loyola University Chicago School of Law, JD 2017 The Department of Health and Human Services (HHS) Office for Civil Rights (OCR) recently agreed to a settlement with Advocate Health Care Network (Advocate), the largest health systems in the Chicago area. In the settlement, Advocate agreed to pay a sum of …
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Detroit Receiving Hospital, an affiliation of Detroit Medical Center Allegedly Used Contaminated Surgical Equipment
Fannie Fang Executive Editor Loyola University Chicago School of Law, JD 2017 On September 15, 2016, Michigan state regulators cited the Detroit Medical Center (“DMC”) for violating the State’s Public Health Code for failing to properly sterilizing surgical instruments. Although DMC promised to address the issue with correction actions, the violation has left an …
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