Monthly Spotlight on Fraud, Waste, and Abuse

Why This Topic Matters

It helps readers understand current enforcement priorities and common compliance risk patterns in healthcare billing and referral relationships. For coding and compliance teams, the article provides context for reviewing organizational practices, documentation, and program integrity concerns.

Article Sections

1. Florida Research Hospital Agrees to Pay More Than $19.5 Million to Resolve Liability Relating to Self-Disclosure of Improper Billing for Clinical Trial Costs

   Discusses a settlement involving research-related billing issues and cooperation with government investigators. The section focuses on a clinical trial and reimbursement compliance matter.

2. Hospitals Pay $7.25 Million to Settle Allegations That They Violated the False Claims Act

   Covers allegations involving hospital affiliation arrangements and federal fraud claims. The section summarizes a civil settlement and whistleblower involvement.

3. New York Hospital Pays Over $800,000 to Settle Claims That Physician Practices Improperly Billed Government Healthcare Programs

   Reviews allegations concerning radiology practice billing and image-guided radiation therapy services. The section also addresses related reimbursement and compliance concerns.

4. United States and State of Washington File False Claims Act Complaint Against Health System for Knowingly Endangering Patients and Fraudulently Billing for Spinal Surgery Procedures

   Describes a complaint involving alleged patient safety concerns, surgical billing, and federal program reimbursement. The section also references prior settlements and whistleblower proceedings.

5. Texas Clinic Owners Agree to Settle Allegations Regarding Acupuncture Devices

   Summarizes allegations involving outpatient billing and device-related claims. The section includes a settlement and exclusion from federal healthcare programs.