Articles Posted in Medicare and Medicaid Fraud

By Szura & Delonis, PLC Artificial intelligence is finding its way into the everyday work of medical practices—from drafting visit notes and answering patient messages to suggesting billing codes and supporting clinical decisions. For physicians, practice administrators, and other healthcare professionals in Southeast Michigan, the question is not simply whether an AI tool saves time.…

You’ve seen something that doesn’t sit right — a pattern of billing for services never rendered, a diagnosis code that doesn’t match the chart, a supervisor who tells you to “just code it this way.” You’re not naive about what it means to raise your hand. You’re wondering whether raising it could cost you your…

You’ve made the decision to come forward. Your attorney has prepared the complaint, gathered your disclosure statement, and filed your case in federal court under the False Claims Act (31 U.S.C. §§ 3729–3733). And then — nothing happens. No hearing date. No defendant response. No public record you can point to. For many whistleblowers, this…

Szura & Delonis, PLC Two federal laws often get invoked in health care fraud cases, and they get confused constantly as well. The Stark Law and the Anti-Kickback Statute (AKS) both regulate financial relationships between physicians and the people or entities they refer patients to — but they work differently, require different proof, and carry…

Most Medicare and Medicaid fraud isn’t uncovered by a dramatic government raid. It’s uncovered because someone inside the organization — a coder, a biller, a nurse, a compliance auditor, an office manager — noticed that the numbers didn’t match reality, and eventually said something. If you’re staring at a billing pattern that feels wrong and…

You know something is wrong. Maybe you’ve seen billing codes that don’t match the chart, or a “consulting agreement” that only exists to reward referrals, or a hospice enrolling patients who plainly aren’t terminally ill. Before you take the leap of filing a qui tam lawsuit under the federal False Claims Act (31 U.S.C. §§…

The State Bar of Michigan Health Care Law Section (HCLS) has named health care lawyer Louis C. Szura as chair for a one-year term (2018-19). Szura, a founding partner of Southfield law firm Szura & Delonis, P.L.C., was selected during the HCLS Annual Meeting on September 20th. The Health Care Law Section is one of…

Government reimbursement is a major sticking point for physicians seeking to incorporate telehealth into their practice. The requirements for government telehealth reimbursement are burdensome and make implementing such services difficult to justify economically, despite the potential benefits to patients and providers. However, earlier this month the Centers for Medicare and Medicaid Services (CMS) proposed significant…