Brian Eastwood

Articles by Brian Eastwood

Cigna faces $66M counter lawsuit from Health Diagnostic Laboratory

Health Diagnostic Laboratory Inc. has filed a counter lawsuit against Cigna, claiming the insurer owes the lab $66 million for legitimate blood-testing services.

OIG calls out CMS for ignoring advice, overpaying $251M for DME infusion drugs

Medicare spent $251 million more than it needed to on durable medical equipment infusion drugs from April 2013 to September 2014, according to a report from the Office of Inspector General--which had spelled out in a February 2013 report exactly how the Centers for Medicare & Medicaid Services could avoid overpaying for such drugs.

Aetna second big-name payer to sue Health Diagnostic Laboratory

Aetna has filed a multimillion-dollar lawsuit against Virginia-based Health Diagnostic Laboratory Inc. The suit alleges that the firm and its former contract sales provider, Bluewave Healthcare Consultants Inc., engaged in fraudulent billing practices.


HCR ManorCare hit with False Claims Act complaint

The Department of Justice has filed a False Claims Act complaint against HCR ManorCare, alleging that the home health provider "knowingly and routinely" submitted Medicare and Tricare claims for rehabilitation therapy services that were not medically necessary.

N.J. Sen. Robert Menendez, Florida eye surgeon indicted on corruption charges

The Department of Justice indicted Sen. Robert Menendez (D-N.J.) on 14 federal corruption charges stemming from his longtime personal and political relationship with Florida ophthalmologist Salomon Melgen, M.D.

Medicare, Medicaid improper payments top $75B in 2014

Medicare and Medicaid accounted for 62 percent of the federal government's estimated $124.7 billion in improper payments in the 2014 fiscal year, according to a Government Accountability Office report.

Aetna hits South Texas hospital with $120 million kickback lawsuit

Aetna has filed a $120 million kickback lawsuit against North Cypress (Texas) Medical Center and its CEO, Robert A. Behar, M.D., claiming it paid kickbacks to physicians for patient referrals and used other improper billing techniques such as upcoding,

Public-private healthcare fraud partnerships aim at prevention

For decades, fighting healthcare fraud has involved a "pay-and-chase" mentality. Recently, though, the focus has started to shift to prevention.

Happy Holidays!

FierceHealthPayer: AntiFraud will not publish a newsletter next Wednesday, Dec. 31 as part of a holiday break. The website will be updated throughout the week. Our next issue will publish Wednesday,...

CMS strengthens oversight of Medicare providers

The Centers for Medicare & Medicaid Services has introduced new "common-sense safeguards" that have removed nearly 25,000 "bad actors" from Medicare, CMS said in a statement today.