The Centers for Medicare and Medicaid Services (CMS) recently released information about new efforts to reform its repayment structure to better address the growing public health crisis of antimicrobial resistance.
Any number of events can trigger a government investigation of a medical facility. The government may receive an anonymous tip, billing practices may lead to a red flag or, as recently highlighted in a case involving the University of North Carolina's (UNC) Congenital Heart Program, negative publicity can snowball and fuel a closer look by government officials.
The federal government recently accused a New York doctor of partaking in a health care fraud scheme that spanned throughout the country. The alleged scheme involved prescriptions for a pain cream in exchange for illegal kickbacks from a pharmacy located in Oklahoma.
State inspectors recently conducted an unannounced inspection of a Connecticut hospital. As a result of this investigation, the state has accused the hospital of mixing up patients’ test specimens.
A recent case out of New York highlights the government's continued crack down on opioid prescription abuse. The case involves an endocrinologist with offices in the Bronx and Yonkers. State officials accused the medical professional of prescribing over 50,000 oxycodone pills to a single patient over a span of five years.
The Office of the Inspector General (OIG) recently conducted an audit of Medicare claims for a specific medical device. The agency found the majority of Medicare claims for this device, the positive airway pressure device and associated supplies, did not comply with Medicare requirements. As a result, the agency called on those who filed claims with Medicare for payment for these devices to “exercise reasonable due diligence to investigate and return any identified overpayments, in accordance with the 60-day rule.”
The college admission scandal was top of the news headlines just a few weeks ago. The scandal involved members of the Hollywood elite along with other wealthy parents paying bribes to get their children spots in prestigious universities. The fallout of the problem remains to be seen as parents fight allegations in court, colleges sort through admissions to determine the best course of action for their universities and students who were often unknowingly the subject of the scandal attempt to get on with their lives.
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.
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.
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.