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June 2020 Archives

NJ doctors: One important lesson from recent kickback case

The U.S. Attorney's Office in New Jersey recently completed an investigation that resulted in health care fraud charges for a medical device company. The investigation was the result of a qui tam lawsuit. This whistleblower claim began when a non-practicing physician filed a complaint about the company, Merit Medical Systems, Inc., stating he formerly worked with the medical device company and that his attempts at encouraging compliance while employed were "to no avail."

3 takeaways from survey of nurses about current challenges

The American Association of Nurse Practitioners (AANP) recently conducted a survey to delve into current challenges faced by those within the profession throughout the country. The organization conducted the survey from May 8th through May 17th, 2020. The survey gathered information about these challenges with a focus on the impact of the novel coronavirus pandemic on the nurse practitioner (NPs) practice. According to the organization, almost 5,000 NPs participated.

Avoid these common mistakes when charged with health care fraud

A recent case out of New York provides multiple examples of what not to do if accused of health care fraud. The case began when the U.S. Attorney's Office of the Western District of New York investigated a psychiatric physician for health care fraud. According to the prosecution, the physician billed for the highest level of evaluation appointments when seeing new patients. When questioned about the need for such an inclusive appointment, the government claims he was unable to provide sufficient evidence to support the claim. Upon further investigation, the government claims the physician routinely up coded and improperly billed for services.

Pharmaceutical rep pleads guilty to health care fraud

The United States Attorney’s office recently announced a 50-count indictment charging seven people with health care fraud, wire fraud and other crimes. The charges are the result of alleged abuse of specialty medication prescriptions for compounded medications. One of the charged is a pharmaceutical representative.

Couple accused of health care fraud, face lifetime imprisonment

The government recently accused two business owners of working together on an elaborate health care fraud scheme that cost the government millions. According to the prosecution, the two business owners, a married couple, put together a health care business to defraud the government.

NCSBN modifies exam to help nursing students during COVID-19

Those who wish to enter the field of nursing must meet many requirements before they are able to begin their profession. One is the completion of the NCLEX exam. The prerequisites to take the exam varies as each Nursing Regulatory Body (NRB) has its own requirements depending on the jurisdiction you wish to practice as a nurse. These requirements are currently under review and many are facing revision as a result of the novel coronavirus pandemic.

Orthopedic practices and health care fraud: 2 misconceptions

Orthopedic practices, like any other medical specialty, can face allegations of health care fraud. The government pursues these allegations aggressively and, if successful, can request penalties that include millions in payment and potential jail time. Additional ramifications can destroy one's medical career as the allegations can result in investigations from the medical board and loss of one's medical license.

AKS violations: A timeline of a typical case

Lawmakers designed the federal Anti-Kickback Statute (AKS) to help better ensure medical professionals focus on the well-being of their patients. Lawmakers intended this piece of regulation to reduce the risk of medical decisions based on financial gain. But what happens when the government accuses a medical company or individual of an AKS violation? The following discussion provides a basic timeline.

Lab owner sues hospital for breach of contract

Running a lab is a rewarding and difficult profession. In some cases, there are business considerations. Contracts may govern these arrangements. In a recent case, a lab owner accused a hospital of failing to fulfill its agreements as listed within the contract. The case involves a lab owner who went into contract with a large health care system to run a cancer research lab. The lab owner is well known within her field. Lynn Hlatky studied physics and biophysics, receiving a Ph.D. from the University of California, Berkeley. Harvard Medical School recruited the researcher and she joined faculty with the radiation and oncology department after developing a “model for cancer” using physics.

The evolution of the AKS to charge labs with health care fraud

The federal Anti-Kickback Statute (AKS) is a key piece of legislation used by the government to prosecute healthcare businesses and practitioners for fraud. The law is broad, and applies to services billed by physicians, nurses and even diagnostic labs.

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