The U.S. Attorney's Office in New Jersey recently completed an investigation that resulted in health care fraud charges for a medical device company. The investigation was the result of a qui tam lawsuit. This whistleblower claim began when a non-practicing physician filed a complaint about the company, Merit Medical Systems, Inc., stating he formerly worked with the medical device company and that his attempts at encouraging compliance while employed were "to no avail."
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.
The current coronavirus pandemic has forced us to rethink our daily lives. We have had to change how we work, how we communicate, and how we get medical care.
A court recently found former Jacksonville Jaguars defensive back Monty Ray Grow guilty of health care fraud and sentenced him to 22 years imprisonment as well as over $19 million in mandatory restitution. The conviction was part of criminal allegations connected to prescription of unnecessary medications to Tricare recipients, a federal insurance program that aids military members.
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.