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.
The Department of Justice (DOJ) recently accused a hospital of Anti-Kickback Statute (AKS) and Stark Law violations. The allegations are the result of claims the hospital paid physicians high salaries based on the “volume or value of the physicians’ referrals.”
The federal government takes health care fraud very seriously. In 1996, the passage of the Health Insurance Portability and Accountability Act (HIPAA) resulted in the development of a national program focused on the investigation and prosecution of those who commit health care fraud crimes. The program, now in effect for over twenty years, has resulted in billions of dollars of awards.
The Department of Justice (DOJ) recently announced collection of over $2.5 billion dollars in judgments and settlements as a result of health care fraud cases. This is the ninth year in a row the government agency has collected over two billion dollars related to this form of fraud.
Allegations of Medicare fraud can extend beyond doctors, nurses and hospital executives. Those in other professions can also find themselves accused of abusing this system. A recent example involves a case out of the Southern District of New York.