Compliance & Legal

Optum, a major player in provider data and finance services, will pay the $12 million San Mateo, California-based Cave Consulting Group for using a licensing methodology for physician analysis that was already patented.

Prime claimed SEIU and Healthcare Workers of the West were guilty of extortion and other illegal methods in their attempts to unionize hospital employees and challenge the company’s $843 million acquisition of the Daughters of Charity Health System in California.

Doctors overstated the amount of time the nurse anesthetists spent with patients, pocketing about 9 percent of the reimbursement.

The agency had argued that the $195 million takeover violated federal antitrust laws and greatly reduced healthcare competition in the southwest Georgia.

Uncertainty created by allowing the providers to go to court on reimbursement rates rather than petition the Center for Medicare and Medicaid Services would have been enough for states to block Medicaid expansion.

Sneakers used as bait to lure low-income and homeless people to corrupt medical clinics, indictment alleges.

For years, the U.S. Department of Justice has been investigating individual facilities within UHS for alleged fraudulent billing practices to Medicare and Medicaid.

Armstrong v. the Exceptional Child Center Inc. ruling is a blow to healthcare providers who say they are losing money in seeing patients covered by Medicaid due to inadequate reimbursement.

In October 2014 ,the company agreed to pay $350 million and another $39 million in civil forfeiture to resolve claims it violated the False Claims Act by paying kickbacks to induce the referral of patients to its dialysis clinics.

The CEO, CFO and COO paid hundreds of thousands in illegal kickbacks to funnel referrals to the cash-starved and now defunct hospital.