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Health Care Investigations Archives

Will recent medical lab breaches lead to more audits?

A data breach impacted an estimated 20 million patients from three medical testing labs. The breach was connected to the collection agency used by the lab to manage billing. At this time, it appears the breach occurred for eight months before the lab became aware of the issue.

Manhattan pharmacist accused of $11 million in insurance fraud

An investigation that spanned many months recently resulted in the arrest of a New York-licensed pharmacist accused of running a “medicine-for-case” scam. The Office of the Insurance Fraud Prosecutor recently announced the charges against this and 18 additional individuals allegedly involved in the scam, which allegedly ran from January through August of 2018.

Former state employee sentenced for health care fraud crime

In 2018, the Department of Justice (DOJ) announced charges against a former state employee for health care fraud violations. The accused waived her right to an indictment and chose to take a plea deal. According to the agreement, the accused confessed to running two social and psychotherapy businesses.

Will the billion-dollar fraud case lead to even more charges?

The government recently announced a billion-dollar health care fraud case. The scam allegedly involved sending Medicare recipients shoulder, knee, ankle, wrist and back braces. In most cases, the patients did not need the braces. In others, the patients never received the braces. The companies would then charge Medicare for the cost of the braces, whether patients received them or not. Ultimately, the government states the scheme resulted in a loss of over one billion dollars.

NY labs: New rule goes into effect in October

The Eliminating Kickbacks in Recovery Act of 2018 (EKRA) is a new federal law that applies to diagnostic and clinical labs throughout the country. The law is a part of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT). It takes effect October 24, 2019.

DOJ accuses dozens of doctors of exchanging sex for prescriptions

The United States Department of Justice (DOJ) continues to crackdown on opioid prescription violations. Most recently, the government has accused multiple medical professionals of illegally prescribing these medications in exchange for financial gain and sexual favors.

Paramedic gets fired after following patient's wishes

A paramedic alleges his employer terminated his position because he followed a patient’s request instead of adhering to conventional medical practices. The patient was suffering from a serious infection and asked the paramedic not to move forward with an intraosseous infusion (IO). The procedure, which essentially involves using a drill like device to insert an IV into the patient's bone, would be the conventional practice recommended in this instance. The patient declined treatment. Instead of pushing or forcing the issue, the paramedic honored the patient's wishes.

ZPIC audits on the rise: Tips for pharmaceutical companies

Zone program integrity contract (ZPIC) audits are on the rise. These audits can result in evidence given to the Department of Health and Human Services (HHS) Office of Inspector General (OIG) and potentially result in criminal charges.

Investigators accuse NY hospital execs of conflict of interest

A recent investigation has resulted in evidence that appears to support allegations a group of hospital executives were more concerned about profits then patient care. The study is an extension of a previous report finding top executives and board members of a local, nonprofit cancer center had benefited due to relationships with drug companies and research projects outside of their normal work duties.

3 tips to avoid allegations of healthcare fraud

The United States Department of Health and Human Services (HHS) continues to crackdown on allegations of healthcare fraud. The government will strike both before and after the fraudulent activity occurs. Predictive analytics allow federal investigators to flag potential violations before they occur. This tool, paired with federal investigations, allows government agencies multiple tools to gather evidence to build support allegations of fraudulent activity.

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