As noted in a previous post, CMS changes tactics, targets health care provider affiliates, the Centers for Medicare and Medicaid Services (CMS) has a new tool in its fight against health care fraud. The tool allows the agency to go after those who affiliate with certain “bad actors,” or other professionals previously accused of health care fraud violations.
New York officials recently accused a local pharmacy owner of partaking in a health care fraud scheme that allegedly led to $2 billion in fraudulent claims to Medicare and Medicaid. According to the indictment, the government moved forward with criminal charges against the pharmacy owner along with twelve other medical professionals including another pharmacy owner, three licensed physical and occupational therapists, a chiropractor and five doctors.
The case against Theranos continues. Questions about the company, based in the health care industry and set to “revolutionize medical laboratory testing” with innovative blood draw and testing methods, began in 2015. Ultimately, investigations resulted in allegations the company made false claims about its ability to provide fast, cheap and reliable blood and lab test results and omitted information about issues with its technologies. These allegations led patients to use their services. As a result, the government charged the founder and an associate with multiple crimes.
Since 2010, the United States Department of Justice has continually increased its focus on health care fraud crimes. Due to this focus, prosecution against those the agency accuses of false billing, illegal kickbacks and other forms of healthcare fraud has steadily increased. The agency recently announced the passage of a new law that will further their ability to increase the rate of these prosecutions.
The Department of Justice recently accused a medical equipment manufacturer of violating the Anti-Kickback Statute (AKS). Whistleblowers began the claim, accusing the company of paying monetary incentives to suppliers and labs to better ensure these medical professionals used their sleep apnea equipment.
Getting a high-level job in the medical world can be difficult. Applicants must have the training and experience to qualify for the position as well as go through the interview process. Once a candidate is offered the job, they may be surprised to find out lawmakers could publicly push back against the decision.
The prosecution's case against Dr. Jorge Zamora-Quezada continues to provide learning opportunities for medical professionals throughout the country. In the most recent development, the government agreed to the acquittal of one of Dr. Zamora-Quezada's employees.
The United States Department of Justice recently announced criminal charges against an MBA student in connection to a health care fraud scheme. The health care fraud scheme involves allegations a health care technology company falsely inflated data and overbilled clients for advertisements. The government claims these practices resulted in over $1 billion in fraudulent gains.
A New York man recently agreed to a plea deal with the government for allegations of health care fraud. According to his plea agreement, the accused requested blank prescriptions from a physician friend. The accused then put in the names of other patients and made copies of the prescriptions to help perpetrate a fraudulent scheme.
The Medicare Fraud Strike Force recently announced the arrest of five New Yorkers based on charges of health care fraud. The arrests were part of a larger coordinated health care fraud enforcement action that led to the arrest of 48 individuals throughout the Northeast in connection to a scheme involving over $800 million in false and fraudulent claims.