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July 2020 Archives

Lab agrees to pay $12 million to settle AKS claim

A diagnostic laboratory recently agreed to pay the government almost $12 million to settle claims that the health care company violated federal Anti-Kickback Statute (AKS) regulations. The government claimed that individuals within the diagnostic lab were illegally bribing health care professionals to use the professional services offered within their lab.

RN gets more than a year imprisonment for health care fraud

Authorities recently announced the sentencing of a registered nurse (RN) to 18 months imprisonment for her role in a health care fraud scheme. As part of the sentence, the court has also required the nurse to pay $9,500 in restitution.

CMS rollbacks and EKRA: A word of caution for diagnostic labs

The United States Centers for Medicare and Medicaid Services (CMS) has rolled back some regulatory provisions in response to the current coronavirus pandemic. Officials reason that these rollbacks will help to better ensure patients can get the testing, diagnosis and treatment needed during these uncertain times.

3 key pieces of evidence used to support healthcare fraud case

A recent healthcare fraud case out of New York, New Jersey and Pennsylvania involves two physicians and multiple other individuals who allegedly used illegal kickback payments to conduct and bill Medicare for unnecessary genetic testing. The government claims to have multiple pieces of evidence to support the claims, including:

Important lesson from recent arrest of NY doctor

New York state authorities recently attempted to move forward with criminal drug charges against a neurologist out of Brooklyn. The doctor states officers falsely placed him under arrest and wrongly sent him to prison for a week. Although the prosecution could not gather enough evidence to support criminal charges, Dr. Itay Keshet states the experience destroyed his career.

EKRA and COVID-19: What do labs need to know?

The United States Department of Justice (DOJ) and the Office of the Inspector General (OIG) have stated they will aggressively pursue health care fraud claims related to COVID-19. These agencies further clarify that they will continue to focus on prosecution for violations of the Eliminating Kickbacks in Recovery Act (EKRA). The announcement comes at an uncertain time, when diagnostic labs are working to help patients who are waiting for testing while living amidst a global pandemic.

Not just for the mafia: Racketeering in medicine

The Racketeer Influenced and Corrupt Organizations (RICO) Act is a federal law that triggers visions of the mafia and other forms of organized crime. Although this law is likely most popular for those types of cases, it can play a role in health care law. Individuals or the government may use RICO charges against those who use legitimate enterprises to engage in criminal activity.

Which court is the right venue for health care disputes?

The answer depends on the details of the allegations. In a recent case, a group of patients filed a class action lawsuit against a New York health system accusing the group of failing to protect their financial, medical and personal information from security leaks. The failure, they allege, resulted in a cyber attack that put the privacy of information like social security numbers in jeopardy.

Two things to know about new HHS proposed rules

The United States Centers for Medicare and Medicaid Services (CMS) recently released proposals that will directly impact the health care industry. Two potential impacts to watch include changes made in response to the current coronavirus pandemic and a potential move to support an increased shift towards the use of value-based drugs.

Did a pharmaceutical company use charity to hide kickbacks?

Federal prosecutors have accused a pharmaceutical company, Regeneron Pharmaceuticals, Inc, of using charitable organizations to funnel illegal kickback payments to doctors. The allegations are connected to the use of an injectable drug used to treat macular degeneration. The company funded a charitable organization, the Chronic Disease Fund, to help cover Medicare patients’ co-pays for this expensive medication.

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