January 27, 2017 | otmseo

Medicare Abbreviations

Medicare and its regulation are replete with abbreviations, acronyms, and content specific phrases. The link below contains a list of 75 and growing. I hope you find this list helpful. If you have any additions, please contact me and I will include them. Mike

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November 2, 2016 | otmseo

Medicare Audits and Appeals

When Medicare conducts an audit of a provider and concludes that an overpayment has occurred it will attempt to recoup that overpayment.  This article will discuss the overpayment appeals process. There are five levels of appeal, each of which is considered a completely new examination of the audit and determination.  Unlike a judicial appeal in […]

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September 2, 2016 | otmseo

Is that Medicare patient Homebound?

One Medicare policy that has seen a boom in litigation, both civil and criminal, in the past few years relates to services being provided to allegedly homebound Medicare beneficiaries.  Homebound status is defined in the Medicare Benefit Policy Manual and states that for a patient to be eligible to receive home health services under Medicare, […]

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August 25, 2016 | otmseo

HHS-OIG Issues Alert to Home Health Agencies and Doctors

Chicago – Not surprisingly in light of the recent charges and convictions of home health agencies (HHA) and related entities in the Chicago area and throughout the country, the Department of Health and Human Service, Office of Inspector General, (HHS-OIG) issued an Alert reporting that the OIG found home health services susceptible to fraud. HHAs […]

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June 16, 2016 | otmseo

Supreme Court up holds Implied False Certification under the False Claims Act

In a resounding victory for whistleblowers, the Supreme Court, in Universal Health Services, Inc. v. United States et al. ex rel Escobar et al., found that a defendant could be liable for violating the False Claims Act under a theory of implied false certification.  This holding supports the proposition that when a defendant submits a […]

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May 24, 2016 | otmseo

Chicago Criminal Defense Lawyer Michael Rosenblat wins fourth not guilty verdict in a row

Chicago Criminal Defense Lawyer Michael Rosenblat wins fourth not guilty verdict in a row. Mr. Rosenblat’s most recent not guilty came on May 13, 2016 when the judge found the defendant not guilty of domestic battery.  The alleged victim claimed that the defendant pushed a heavy object into her knocking her to the ground.  In […]

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May 14, 2016 | otmseo

Defendants Have the Right to Hire the Attorney of their Choice

Twenty dollar bills isolated against white background. The Defendant Sila Luis was charged with stealing over $45 million by allegedly paying kickbacks and conspiring to commit fraud, all related to health care.  Luis wanted to hire her own attorney, but the government froze all of her funds, even those funds unrelated to the crimes she […]

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April 4, 2016 | otmseo

Who Let the Dogs In?

 Supreme Court of Illinois holds that use of a drug-detection dog violated Fourth Amendment in People v. Burns. On January 10, 1013 at 3:20 am, the police along with a drug-detection dog went into defendant’s apartment building.  This officer and his dog got into the building when a tenant let in a fellow officer, who […]

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March 3, 2016 | otmseo

Court clarifies Loss Calculation and Restitution

Chicago – In United States v. Pu, 2016 U.S. App. LEXIS 3224 (7th Circuit February 24, 2016), the court addressed the district court’s loss calculation and restitution order.  Pu who worked for two companies, one of which was the Citadel in Chicago, a hedge fund, was indicted for and pleaded guilty to unlawful possession of a […]

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February 3, 2016 | otmseo

Stericycle agrees to $29m settlement in False Claims Act case – MassDevice

A federal judge in Illinois yesterday approved a settlement agreement between Stericycle (NSDQ:SRCL) and the plaintiff in a  whistleblower lawsuit accusing the medical waste disposal company of overbilling federal and state governments to the tune of some $13.6 million. Jennifer Perez, a government customer relations specialist at YY-based Stericycle from 2004 until March 2008, filed a qui tam lawsuit in 2008 alleging […]

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