Author Archives: Staff

As part of its efforts to eliminate healthcare fraud, The Centers for Medicare & Medicaid Services (CMS) will require approximately 750,000 physicians in the Medicare program to revalidate their individual enrollment records. Moreover, CMS announced on August 10th that eventually, it will send revalidation requests to more than 1.4 million health professionals between now and March 23, 2013. This revalidation effort has received criticism, with doctors describing Medicare enrollment as tedious and confusing. American Medical Association (AMA) President Peter W. Carmel, MD states, “We have very significant concerns with this revalidation effort in light of the problems physicians have had with enrollment and revalidation efforts in the past…the AMA is making this a priority and urging CMS to reconsider this action.”

Read more at: http://www.ama-assn.org/amednews/2011/08/29/gvl10829.htm

Eleven Texas cities will pay $1.69 million to federal and state governments in order to resolve false claims and healthcare fraud claims. Investigations began when whistleblower Douglas Moore brought a suit in February 2010. Although the cities have yet to admit any wrongdoing, they agreed to resolve the “upcoded” claims submitted to Medicaid for city-dispatched ambulances.

Read more at: http://www.courthousenews.com/2011/08/25/39256.htm

The attendees at the Florida Alliance of Retired Americans gave vigorous support and endorsement for the Affordable Care Act. Regional director of the Department of Health and Human Services, Anton Gunn, stated, “Since the passage of the Affordable Care Act, the state of Florida has been awarded $110 million, and 255,000 people have been supported with prescription drugs.” However, Gunn also noted that Palm Beach County is “ground zero for Medicare fraud.” He added, “we have to staff a whole office and hire 68 new agents from the FBI Academy.” Among other suggestions, individuals also supported the idea of a single-payer health care system as well as a universal health care bill.

 
To read more, go to: http://www.sun-sentinel.com/news/palm-beach/delray-beach/fl-drf-healthcare-0824-20110824,0,27328.story

The SEC’s new whistleblower policies make it seem as if wealth and bounty are just “one shrill blast away.” However, by showcasing two very different, but equally difficult cases, this article argues that undergoing the process of whistleblowing, even under the new SEC rules, is rigorous and challenging.

To read more, go to: http://www.law.com/jsp/cc/PubArticleCC.jsp?id=1202512145469&New_SEC_Rules_Promise_Payouts_for_Whistleblowers_but_How_Have_Past_Tipsters_Fared

U.S. District Judge Robert Sweet rejected JPMorgan Chase & Co’s bid to dismiss a whistleblower lawsuit brought by Jennifer Sharkey, a former private banker for the company. According to Sharkey, she was fired in retaliation for voicing her suspicions about an Israeli client, who was reported to have undocumented businesses and unexplained funds transfers. Furthermore, the client allegedly engaged in business with Columbia, despite the New York-based JPMorgan’s ban on transactions with the country. Sharkey notes that the client generated approximately $600,000 of annual business for the bank.

Read more at: http://www.insurancejournal.com/news/national/2011/08/22/211791.htm#