“Health care fraud is not a victimless crime, because fraudulent billing ultimately affects consumers who must pay the cost of higher insurance premiums.” -United States Attorney Peace. The Department of Justice’s press release discussed a federal jury on Long Island returned a guilty verdict on eight counts of charges against Mathew James. He perpetrated a
“Grossly and materially substandard” The Port City Daily reported another settlement involving SavaSeniorCare. The allegations include that Sava billed Medicaid for medically unnecessary services. Sava also failed to meet standards for nursing and custodial services. For years, Sava allegedly schemed to maximize billing and caused therapist to provide “unreasonable and unnecessary” rehabilitation services. The Georgia-based
Payor Source McKnight’s had an article showing discrimination in the nursing home industry. The industry uses discriminatory tactics to reject less profitable residents. Ashvin Gandhi is an industry expert. Gandhi is a health economist and assistant professor at UCLA. Gandhi explained that existing law shows that disability discrimination is “clearly illegal” through the Rehabilitation Act,
Medicare officials are trying to determine whether to cover aducanumab or Aduhelm. Since last year, Medicare has been evaluating whether to pay for a new expensive drug to treat Alzheimer’s disease. The F.D.A. approved the “miracle” drug. However, aout 40% of patients who have taken it have suffered swelling or bleeding in the brain. Alzheimer’s disease is twice
For an industry where profit margins are widely discussed, financial transparency is nonexistent. For decades, the industry claims they cannot provide care under the old reimbursement models. However, the new Patient-Driven Payment Model (PDPM) model was not budget neutral. Therefore, the Medicare Payment Advisory Commission (MedPAC) suggested a modification to keep base payment rates budget
“Surprise bills” are extra charges from a medical provider whom patients didn’t choose. These medical bills add insult to injury. Surprise bills from anesthesiologists, radiologists, pathologists, assistant surgeons and laboratories were common before a new law “No Surprises Act” signed by Biden. As a nursing home attorney, we see clients shocked at the cost of medical bills.
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