tci ED Coding & Reimbursement Alert - 2016 Issue 9

Compliance: Recent Supreme Court Ruling Expands Reach of the False Claim Act

Does an improper licensed provider submission constitute a false claim under the law? The US Supreme Court recently released its decision on the case of Universal Health Services. v. U.S. ex rel.Escobar, in which a young woman received mental health and therapeutic services from healthcare providers employed by Universal Health Services (UHS).  The young woman later had a fatal seizure and her parents sued UHS under the federal False Claims Act (FCA), as several of the providers were later determined to not have been properly licensed under state law. UHS coded, billed and received reimbursement for...

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