• FDA sued over rule to regulate hospital lab tests

    A national trade group representing laboratories filed a lawsuit against the FDA on May 29, arguing the agency's recent final rule to treat laboratory-developed tests as medical devices exceeds its statutory authority. 
  • Senators press MultiPlan on out-of-network claims fees

    Vermont Sen. Bernie Sanders and Oregon Sen. Ron Wyden are seeking information from MultiPlan after an April 7 New York Times report found that major insurers made millions in fees by using the data analytics firm to determine how much to pay for out-of-network claims. 
  • Providers want better Medicare Advantage prior auth data

    The Medical Group Management Association said that as the number of Medicare Advantage beneficiaries continues to grow, "it is imperative that the MA program ensures adequate and transparent coverage to patients, timely payment to medical groups and remains a viable pathway for medical groups to participate in value-based payment arrangements."
  • Tips on strengthening vendor risk management for healthcare compliance

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  • Federal bill seeks to curb 340B eligibility

    On May 28, representatives from three states introduced a federal bill to amend the 340B program by recognizing contract pharmacies, restricting pharmacy benefit managers and tightening eligibility criteria. 
  • Pennsylvania system to pay $735K to settle physician whistleblower suit

    DuBois, Pa.-based Penn Highlands Healthcare has agreed to pay the federal government $735,000 to resolve a whistleblower suit alleging Physician Self-Referral Law violations from claims submitted to Medicare and Medicaid.
  • Ex-Erlanger executives allege kickbacks in whistleblower lawsuit

    Two former high-ranking employees have filed a False Claims Act complaint against Chattanooga, Tenn.-based Erlanger Health System.
  • Louisiana categorizes abortion pills as controlled substances

    Louisiana is the first state to define medication abortion, an FDA-approved two-drug regimen, as a controlled substance, meaning possession of unprescribed abortion pills can lead to imprisonment. 
  • Texas physician convicted of $70M Medicare fraud scheme

    A Fredericksburg, Texas physician was convicted for causing the submission of more than $70 million in fraudulent claims to Medicare for medically unnecessary orthotic braces and genetic tests ordered through a telemarketing scheme.
  • PE-owned physician group backed Florida C-section policy shift

    A debated Florida law that allows physicians to perform cesarean deliveries outside of hospitals came about after backing by a private equity-owned physicians group, according to KFF Health News.
  • Police probe murder-suicide at Virginia hospital

    Newport News (Va.) police are investigating an apparent murder-suicide that took place at Riverside Regional Medical Center on May 26. 
  • Las Vegas physician convicted in $2M fraud scheme

    A physician was convicted by a Nevada federal jury for his role in a nearly $2 million Medicare and Medicaid fraud scheme.
  • Mississippi man pleads guilty to $51 million healthcare fraud scheme

    A Mississippi man who owned, operated, had financial interests in, or was affiliated with pharmacies, durable medical equipment companies and a laboratory pleaded guilty to his role in a $51 million Medicare fraud scheme. 
  • Physicians plead guilty to defrauding major payers

    A pair of pain physicians pleaded guilty to conspiring to defraud three major payers by submitting claims for corticosteroid injections that were never administered. 
  • Medical devicemaker to pay $42M in malfunctions case

    On May 20, Massachusetts-based Magellan Diagnostics agreed to pay $42 million and pleaded guilty to charges related to the concealment of a device malfunction. 
  • Kansas physicians push back against new abortion reporting law

    Kansas residents voted in 2022 to protect abortion access up to 22 weeks of pregnancy, but a new law requires physicians in the state to publicly report a patient's reason for choosing the procedure and also disclose certain personal details about them.
  • Orthopedic surgeon sentenced to prison for upcoding scheme

    A Massachusetts-based orthopedic surgeon was sentenced to 16 months in prison after being convicted for his role in an upcoding scheme. 
  • 10 recent hospital lawsuits, settlements

    From the Connecticut Hospital Association filing a lawsuit against Prospect Medical Holdings to the Cleveland Clinic settling False Claims Act allegations, here are 10 lawsuits, settlements and legal developments Becker's has reported since May 6: 
  • Judge orders Memorial Hermann transplant surgeon to retain texts, emails

    A Texas judge has granted a temporary injunction against a transplant surgeon at Houston-based Memorial Hermann-Texas Medical Center accused of altering patient records, potentially preventing some patients from receiving lifesaving care, the Houston Chronicle reported May 20.
  • CMS aims to expedite EMTALA probes

    CMS will now allow patients to directly file Emergency Medical Treatment and Labor Act complaints with the federal government.
  • Hospice owner gets 20 years in prison for $84M fraud scheme

    A New Orleans hospice owner was sentenced to 20 years in prison after a federal jury found him guilty for orchestrating a scheme that billed Medicare for $84 million in fraudulent claims. 

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