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FALSE CLAIMS ACT — Qui Tam

The United States District Court for the Eastern District of Pennsylvania refused to dismiss a qui tam lawsuit brought against several mental health clinics and their directors and corporate owners who were alleged to have violated the False Claims Act by allowing an excluded individual (who had been convicted of Medicaid fraud) to continue to run the clinics while the defendants knowingly covered up his involvement. The lawsuit also alleged that the clinics falsified credentialing records to make it appear that some employees were hired later, thus covering up the fact that those individuals began working before earning the requisite degrees. Further, the lawsuit alleged upcoding for medical check visits and that therapists were insufficiently supervised for billing purposes.

Smith v. Carolina Med. Ctr.

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Question of the Week

The Chief of Staff recently implemented a precautionary suspension after a Medical Staff member engaged in some seriously unprofessional behavior that was thought to compromise patient safety. The MEC met to review the matter and lifted the precautionary suspension after four days. A formal investigation was commenced and that process is now complete and the MEC is considering suspending the practitioner for 30 days. For purposes of reporting to the National Practitioner Data Bank (NPDB), will that suspension be added to the four-day suspension he already served – meaning that it will constitute a 34-day suspension and

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