Kevin Bradberry

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Exaggerated Diagnosis Codes and Inadequate Provider Networks: Allegations of Medicare Advantage Fraud Settled for $32.5 Million

By Kevin Bradberry on June 20, 2017 Posted in Uncategorized

The latest settlement involving Medicare Advantage (MA) organizations highlights not only the government’s continuing enforcement focus on Medicare Part C but also the vulnerabilities inherent in that program. In United States ex rel. Sewell v. Freedom Health, Inc. et al., two Florida-based MA organizations – Freedom Health and Optimum HealthCare – agreed to pay $32.5 … Continue Reading

HHS Ordered To Eliminate Medicare Appeals Backlog By 2021

By Kevin Bradberry on January 25, 2017 Posted in Uncategorized

On January 4, 2017, the U.S. District Court for the District of Columbia rejected a request by the Secretary of HHS asking the court to reconsider its decision that requires HHS to eliminate the backlog of Medicare claims appeals pending at the Office of Medicare Hearings and Appeals (OMHA) by 2021. While “not unsympathetic to [the … Continue Reading

The 60-Day Rule: Failure to Return Overpayments Caused by Software Glitch Costs Hospital $2.95 Million

By Kevin Bradberry on October 31, 2016 Posted in Uncategorized

A software glitch can be just as risky for a healthcare provider as submitting a false claim. Or so it was declared on August 24, 2016 when the U.S. Attorney for the Southern District of New York announced that Continuum Health Partners, Inc. and two of its New York City network hospitals would pay $2.95 … Continue Reading

Differences in Medical Opinions: Not Enough to Prove FCA Liability

By B. Scott McBride and Kevin Bradberry on May 23, 2016 Posted in Uncategorized

In a $200 million False Claims Act (FCA) litigation with certain twists and turns, the U.S. District Court for the Northern District of Alabama recently found that the federal government failed to show that claims submitted to the Medicare program by hospice defendant AseraCare were in fact false. The court held that because the only … Continue Reading