$450K Medicare Settlement to US Government for Allegations Under False Claims Act
A Connecticut healthcare facility agreed to a $450,000 settlement to the U.S. government recently for allegedly violating the federal False Claims Act by falsifying and then covering up billing records regarding Medicare/Medicaid payments.
New York City criminal lawyers at Bernfeld, DeMatteo & Bernfeld, L.L.P. have assisted the SettlementBoard editorial team in identifying topics of importance to readers of this blog.
It was revealed in Myrecordjournal.com in Masonicare to pay nearly $450,000 in Medicare/Medicaid settlement that Masonicare Health Center of Wallingford had allegedly falsified billing codes in administering injections of leuprolide acetate to Medicare and Medicaid patients.
The drug, also known as Lupron, is used to treat prostate cancer in men and fibroids and endometriosis in women. Medicare/Medicaid reimburses at a higher rate if the drug is used on women.
The government in its suit against Masonicare alleged that the facility routinely billed for the female-related code despite injections given to men. Further, the government maintained that Masonicare had discovered the discrepancy in 2009 but failed to notify the government or offer to reimburse it for the overpayments.
The False Claims Act provides for triple damages and civil penalties for liability under the act if a facility fails to notify and promptly reimburse the government for overpayments. The facility agreed to pay $447,776 for its actions between January 1, 2001, to May 31, 2010.
The amount that Masonicare was overpaid was not disclosed. The facility also denied liability but agreed to the settlement to end the litigation.
Why Do You Need a Bad Faith Insurance Lawyer?
When the insurance works the way as it should -- for automobile, health, fire, or water damage -- it can be a lifesaver, especially during times of extreme financial, physical, or emotional distress. But when your insurance company does not keep its promises, the consequences can be devastating.
When an insurance company intentionally or unreasonably refuses to pay on a claim, that company has likely crossed the line into bad faith. It is accountable not only for the benefits on the policy, but also for any additional damages its actions have caused, as well as punitive damages in the resulting case.
What is bad faith?
Insurance bad faith is a legal term that describes a tort claim that an insured individual may have against an insurance company for its actions. To decide whether an insurance company has acted in bad faith, the courts must look objectively at the customary course of business in the industry, as well as at the insurance company's actions.
Dealing with bad faith is complicated and requires legal assistance. You should contact experienced Phoenix insurance lawyers who are familiar with bad faith laws and successfully worked on similar cases to yours.
Remedies for Aggrieved Policyholders in Staten Island, NY
Everyone relies on some type of insurance every day. But if policyholders feel like they are not getting the benefit of that insurance policy, the policyholder can take action against the insurance company. The most common types of actions are breach of contract and breach of duty of good faith and fair dealing.
Breach of Contract
An insurance company can be liable for breach of contract if it fails to do what it is written under the insurance policy or contract. Generally, insurance companies draft the policies in such a way that they have more authority than the insureds. As a result, insurance laws have evolved to favor insureds by providing that contractual ambiguities should be construed in favor of the insured and that exclusions from coverage should be construed narrowly.
Breach of the Duty of Good Faith and Fair Dealing
The insurance company has a duty to deal with their insureds fairly and in good faith. The insurance laws imply this duty in every contract. The core of a bad faith claim is whether the insurer acted reasonably. If it did not, many states allow juries to assess more extensive damages than in a standard breach of contract suit, including punitive damages.
The legal process to challenge an insurance company's actions can be complex. An attorney can guide you through the process and help you recover the damages to which you may be entitled. If you have an issue with your long-term disability insurance policy, elder law attorneys in Staten Island can help.
What are the Goals of Insurance Coverage Litigation?
Insurance coverage claims are best handled by an attorney with knowledge and skill in insurance law. The most important goals of insurance coverage litigation are to:
- Minimize the danger of loss
- Provide a remedy to the insurer instead of waiting for the insured to take initiative
- Avoid multiple suits
- Achieve a speedy and more economical resolution
Insurance Coverage Disputes
Insurance coverage disputes arise between the insurance company and an insured party. Coverage disputes generally occur for claims that include:
- Uninsured or underinsured motorists claims
- Flood claims
- Fire claims when arson is suspected
- Homeowner claims
In the state of Illinois, insurance coverage disputes of less than $50,000 and all uninsured and underinsured motorist claims are resolved by negotiation. In the state of Missouri, however, it is resolved through litigation.
Insurance Defense Lawyers Can Guide You
Insurance coverage litigation is not a simple process. To obtain a fair verdict, you need skilled representation from an experienced insurance attorney. An insurance defense lawyer in Edwardsville with experience in insurance coverage litigation can help you to resolve issues related to insurance -- including declaratory judgment and insurance coverage disputes.