The United States Department of Justice (DOJ) recently announced it was pursuing allegations of health care fraud against a spine device manufacturer along with its executives.
The government uses the Anti-Kickback Statute (AKS) to help better ensure doctors are not letting financial gain impact decisions about patient care. As a result, the government may make an AKS claim if a doctor is getting payment or has some financial benefit from an arrangement with other health care providers.
Patients are not the only ones who pay the bill when it comes to medical care. In some cases, the government is also spending money. The government may pay the entire or a portion of the bill, for example, for Medicare patients. As a result, lawmakers have put various regulations in place to better ensure the money is used as it is intended.
The Centers for Medicare and Medicaid Services (CMS) recently released a proposal to change the Stark Law. The proposal is not current law, but the agency has stopped taking public comments.
Lawmakers are encouraging the United States Department of Health and Human Services (HHS) to increase oversight of patient assistance charities. These charities are set up to help pay for the cost of prescription medications. However, there are allegations the charities are involved in Anti-Kickback Statute violations. As a result, lawmakers are calling for increased regulation of patient assistance charities.
On October 9, 2019, the United States Department of Health and Human Services (HHS) proposed some of the largest changes to the Stark Law, which guides physician self-referrals, and the Anti-Kickback Statute (AKS) discussed in decades. The proposals are part of the government’s broader attempt to encourage coordinated care efforts.
The government has continued its prosecution of those connected to a health care fraud case that extended past borders in what the Justice Department has called “one of the largest health care fraud schemes prosecuted to date in the U.S.”
The Department of Justice (DOJ) recently charged 30 in a "patients for cash" health care fraud scheme. According to the indictment, a home health organization illegally paid doctors, nurses, and at least one social worker along with other medical professionals in violation of the Anti-Kickback Statute (AKS) for referral of patients to a home health organization.
Novartis Pharmaceuticals Corp. (Novartis) recently announced it will set aside $700 million to settle claims made by the Department of Justice (DOJ). The DOJ recently accused the pharmaceutical giant of illegally bribing physicians and other health care professionals to prescribe their medications.
The government continues to crackdown on allegations of health care fraud. One recent example involves a pharmacist accused of various crimes. According to the complaint, the prosecution has charged the pharmacy owner with two crimes. The first is conspiracy to commit health care fraud and the second conspiracy to pay illegal kickbacks to a physician.