Using Technology to Enhance InvestigationsIn addition to ramping up the “muscle” behind criminal health care enforcement, the government is now employing more cutting-edge technology to ferret out potential fraud. One such technology is data mining. For example, on February 28, 2012, the DOJ arrested Dr. Jacques Roy and six other individuals for their alleged participation in a health care fraud scheme involving approximately $375 million – the single largest fraud amount orchestrated by one doctor in the history of the Strike Force. The government discovered Dr. Roy’s activities through data mining – not through a whistleblower or other, more traditional, investigative techniques. Through data analysis, the government was able to detect a spike in the number of patients that Dr. roy certified for home health care services. HHS Inspector General Daniel Levinson commented that “[i]n this case, our analysts discovered that in 2010, while 99 percent of … [Read more...] about Industry Trends in Criminal Health Care Fraud Enforcement
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CMS proposes to exclude patient days associated with hospice patients receiving inpatient hospice services in an inpatient hospital from the Medicare and Medicaid fractions of the disproportionate patient percentage (DPP) calculation. Likewise, these inpatient hospice stays are excluded from calculations of available bed days. Medicare beneficiaries who receive hospice care can receive inpatient hospice care in a hospital for pain control, symptom management, and respite care needed to provide temporary relief to family or other care givers. Because these patients are receiving a hospice benefit, CMS proposes to exclude these patient days and bed days from the DPP calculation and the DSH payment adjustment. It is important to note, however, that acute care services provided to a hospice patient to treat a condition unrelated to the patient’s hospice plan of care (e.g., a broken bone) are not excluded from the DPP calculation or the DSH payment adj … [Read more...] about CMS Publishes Proposed Policy and 2012 Payment Changes for Stays in Hospitals and Affordable Care Act Quality of Care Provisions
Review your policies’ defense and notice provisions. If claims are made frequently against your company, make sure that the defense and notice provisions in your liability policies are consistent with your internal claims handling practices. Is there a reporting requirement for all claims or only those claims of which the risk manager, in-house counsel, or c-level executives are aware? Does the policy permit notice of circumstances? Does it require notice of oral claims? If you don’t want to have to notify the insurer of claims below a certain liability exposure threshold, make sure your policy’s notice provisions permit delayed notice. Otherwise, a small claim that becomes a big claim may not be covered if you didn’t provide timely notice. If you want to be able to select your own defense counsel and control your own defense, make sure that the policy gives you that right. … [Read more...] about Best Practices for Protecting Your Company With a Successful Insurance Renewal
“The similarities in Alabama and Ohio suggest that spending on judicial elections may occur in stages,” said Adam Skaggs, senior counsel at the Brennan Center. “Spending spikes while opposing sides battle for control in key states, and then falls sharply, along with electoral competition, when the court elections lead to a clear winner and a clear loser over several cycles. In states with captured courts, a decline in overall election spending does not mean that special interests have abandoned their efforts to influence the courts; it just means that one side has won the current phase of the arms race.” … [Read more...] about Campaign Money Patterns Entering New Phase in 2012 Judicial Races
This summer the ABA, along with Glassdoor, Salary.com, LawyerEdu.org and the National Association for Law Placement published statistics about attorney salaries by practice area. And the makers of Practice Panther law practice management software combined the data to create this list. They suggest it might be useful to law students debating which practice area to choose. (It can also bring joy or jealousy to those already in a certain areas.) … [Read more...] about How much money can you make in different practice areas?