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.
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.
The United States Centers for Medicare and Medicaid Services (CMS) made many changes to its rules in response to the current coronavirus pandemic. Three that directly impact healthcare include:
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.
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 United States Department of Justice (DOJ) recently announced criminal charges against two New England men. The agency claims the men were attempting to defraud the government’s recently unveiled small-business lending program — a program lawmakers intended to provide aid to small businesses struggling to survive during the current coronavirus pandemic.
A recent case provides an example of how the government moves forward with a case of health care fraud that may involve an unlikely offender and the types of penalties that can apply. According to the Federal Bureau of Investigation (FBI), the accused in this case was a youth football coach.
An ear, nose and throat (ENT) practice recently agreed to pay the government along with local state authorities over $9 million to settle claims they violated the federal False Claims Act (FCA) and state regulations.
The government has stated it is prepared to go after those who commit health care fraud to receive funds set aside to help deal with the coronavirus pandemic. True to its word, the Department of Justice (DOJ) has already reported one action against health care fraud related to the coronavirus. The agency states it moved forward with an action against a website offering a free vaccine against COVID-19 - patients need only pay the $4.95 shipping and handling fee. It has since ordered the website to shut down the offer.
The governor of New York recently announced another legal tool it will use in its fight against the current opioid epidemic. According to Gov. Andrew Cuomo, the state’s Department of Financial Services (DFS) has filed an insurance fraud action against one of the major opioid manufacturers in the area.