After over ten years of investigating and searching, the United States Department of Health and Human Services has recaptured and charged a man with healthcare fraud. In response to the initial charges made ten years ago, the accused fled. He left the country and, until recently, was in Haiti.
The New York state and federal government recently conducted an investigation into the operations of a local skilled nursing provider. The center under investigation provides long-term care services to patients in the community. These services can include adult day health care and skilled nursing visits to patients’ homes.
The Department of Justice (DOJ) accused a large drug company of paying kickbacks to medical professionals to encourage the physicians and nurse practitioners to prescribe their medications. The DOJ’s has accused the company of using kickbacks to encourage the prescription of a powerful, opioid pain medication approved by the Food and Drug Administration for cancer patients for the treatment of persistent pain for non-covered uses.
The New York State Attorney General recently sentenced a pharmacist for his role in a healthcare fraud scheme. The government accused the medical professional of filing over 1.5 million in fraudulent payments with the New York State Medicaid program.
Medical professionals often rely on payments from Medicare for services provided to patients. The United States Department of Health and Human Service’s Centers for Medicare and Medicaid Services administers this program and requires medical professionals meet certain criteria to receive payment. In some situations, the government can choose to exclude a professional’s ability to request payments.
A data analytics firm has accused a healthcare provider of False Claims Act violations. The group states the provider illegally received payment for over $188 million in Medicare claims. If the suit is successful, the firm would receive a portion of the winnings.
The United States Department of Justice Medicare Fraud Strike Force is a government group put together with one focus: take down medical professionals and others that are committing health care fraud. As noted in a recent publication by the New York Law Journal, this group is very successful at this task. It is responsible for the conviction of thousands of medical professionals across the nation.
The government recently accused three physicians out of Long Island for taking part in a health care fraud scheme that cost the Medicare and Medicaid program approximately $163 million in fraudulent charges. The physicians were investigated by many government agencies, including the Justice Department (DOJ), Internal Revenue Service (IRS), Federal Bureau of Investigation (FBI) and the New York State Office of the Medicaid Inspector General.
The Department of Justice (DOJ) recently announced a settlement between the government and a family of integrated hospitals and health care providers that operate in New York. The settlement includes an agreement to pay the State of New York $895,427 and an additional $14 million to resolve allegations of violation of the False Claims Act.
As noted in the previous piece, Government and health-care fraud, Part 1: Why the crackdown?, the United States government has stepped up its efforts to prosecute those who are accused of health-care fraud. The main motivation for these efforts is money. The government stands to lose billions every year through this form of crime.