A recent case emphasizes the importance of including zero-paid claims in statistical sampling. When claims for which no payment was made—referred to as “zero-paid” claims—are excluded from the sampling frame, it raises significant due process concerns. This was the key issue in the case brought by MedEnvios, a healthcare supplier, which argued that the failure
Desperation: How An Aging Parent Got His Abusive Son Out Of His Home
Here at AgingParents.com, we see a broad range of elder-related problems. This one was a first. It is a true case, one a solo ager can learn from. If you are aging and living alone, take heed.
The Facts:
Aging veteran (AV) was living alone, and struggling with being disconnected from others. He was
Medical: Publication of a book.
Grant v Health Ombudsman [2024] QSC 146 (Link to Queensland judgments)
With thanks to Tina Cockburn for drawing attention to this decision.
The applicant psychiatrist published a book in 2018 called Killer Instinct: Having a Mind for Murder. He had been the subject of complaints arising out of the content of the Book, which
BPU Seeks to Reevaluate NJ’s Solar Renewable Energy Credit Competitive Solicitation Incentive (CSI) Program
The NJ Board of Public Utilities (BPU) has scheduled a stakeholder meeting for Tuesday, September 17, 2024, for the purpose of receiving comments and input regarding the Competitive Solicitation Incentive (CSI) component of the New Jersey solar energy renewable energy certificate program, sometimes referred to as the Successor Solar Incentive (SuSI) Program. Alternatively, stakeholders are
Tapping the Pediatric and Orthodontic Dentistry Market, With Ananya Shah and Will MacInnis
There are already big players in the pediatric and orthodontic space, so what inspired Ananya Shah and Will MacInnis to launch their own dental service organization? The answer lies in untapped markets and “a ton of opportunity.”
With host Geoff Cockrell, Ananya and Will outline their journey from running a tech-focused healthcare start-up
HHS OIG won’t enforce antifraud statutes against patient assistance program
The Department of Health and Human Services Office of Inspector General (“OIG”) recently issued a favorable advisory opinion regarding whether a proposed patient assistance program (“PAP”) would run afoul of Federal antifraud statutes.
Under the proposed PAP, a nonprofit organization would subsidize certain cost-sharing obligations for low-income Medicare enrollees who have diabetes and reside in
Kelly Shivery Publishes “False Claims Act 101” in the Quarterly Journal of NALA
Kelly Shivery, an Advanced Certified Paralegal at Whistleblower Law Collaborative, authored an article published in the September 2024 issue of Facts & Findings, the Quarterly Journal of NALA. Her piece, “False Claims Act 101,” offers a comprehensive overview of the False Claims Act (FCA), covering its origins, the components of a qui tam case,
Connecticut Dentists Settle Kickback Claims
Three Connecticut dental practices, together with their owners, have agreed with the U.S. Attorney’s Office for the District of Connecticut to pay $1.7 million to settle allegations that the practices violated federal and Connecticut False Claims Acts and the federal Anti-Kickback Statute. This and other recent settlements seem to be suggesting that a crackdown on
Medical: Polsen v Harrison appeal (NSW).
Polsen v Harrison [2024] NSWCA 224 (Link to Caselaw).
Set out below is the headnote provided by the Court in relation to this decision, which arose from bariatric surgery.
Facts
On 22 July 2013 Dr Richard Harrison (the respondent) performed a laproscopic sleeve gastrectomy on Katrina Polsen (the appellant) at Calvary Hospital, Wagga Wagga. She developed an intra-abdominal
Update to parents regarding DAC eligibility for continued Medicaid
[Original Post on June 4, 2024]
The solution of the DAC being illegally counted by Florida Medicaid could be remedied by SSA. We have started the process to petition SSA to change its rules to do that.
However, that process is going to take much, much longer than we anticipated.
Therefore, we are suggesting to all