New York Attorney General Letitia James has accused a Long Island pharmacist of a complex, multi-million-dollar Medicaid scam. The scam, according to prosecutors, involved pharmacies throughout New York including locations in Manhattan and the Bronx.
Technology has touched every area of our lives. We have devices in our pockets that allow us to be in constant contact with our loved ones and colleagues, our vehicles are beginning to use the technology needed to drive themselves and our refrigerators can tell us when we need to stop at the grocery store.
The government continues to pursue Insys related healthcare fraud investigations. Insys Therapeutics (Insys), a pharmaceutical giant, is known for manufacturing Subsys, a fentanyl-based spray used for management of severe pain suffered by cancer patients.
The government recently accused a professional counselor of taking part in a complex health care fraud scheme. The prosecution accused the counselor of filing false documents to incorporate the counseling business, completing unnecessary tests of patients receiving treatment at the center and using employed doctor’s medical licenses to fraudulently prescribe and move drugs.
New York State Police recently collaborated with various federal, state and local agencies to conduct an investigation of a transport service accused of defrauding Medicaid. The investigation spanned two years. Upon completion, New York officials arrested thirteen transport drivers. The prosecution has accused the drivers of fraudulently charging the government for their services.
Health care fraud disputes were present throughout 2018. These cases included everything from individual physicians, nurses and other health care professionals fighting boards for their professional licenses to multi-million dollar Anti-Kickback Statute (AKS) violations cases — as discussed in a previous post, available here.
A health care executive known for running nursing and assisted living facilities in Chicago before expanding to Florida will begin trial within the next two weeks. The government has accused the former exec of his role in a scheme that allegedly defrauded Medicare of over $1 billion in false claims. The accused ran approximately 20 facilities and allegedly filed for claims with Medicare for services that were either never provided or unnecessary. The prosecution has also stated the business owner paid illegal kickbacks to physicians to encourage referrals to his facilities.
New York State law requires individuals meet certain requirements before they can call themselves a pharmacist. These requirements include the applicant hold a license as well as have good moral character. Additional requirements include:
Healthcare fraud occurs when the government makes an accusation that someone filed false healthcare claims for financial gain. The government can accuse medical professionals throughout the healthcare field of a violation. Examples include:
The False Claims Act (FCA) makes it illegal to use false or fraudulent claims to seek payment from government sources, like Medicare and Medicaid. This law is complex. Court cases have questioned the best way to apply the FCA to establish a violation. These cases often require the plaintiff establish four elements: "(1) a false statement or fraudulent course of conduct, (2) made with scienter, (3) that was material, causing (4) the government to pay out or forfeit moneys due." The outcome of these cases often hinges on the scienter and materiality elements.