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Health Care Investigations Archives

3 ways the DOJ will use the FCA during the pandemic

The government has stated it is prepared to go after those who commit health care fraud to receive funds set aside to help deal with the coronavirus pandemic. True to its word, the Department of Justice (DOJ) has already reported one action against health care fraud related to the coronavirus. The agency states it moved forward with an action against a website offering a free vaccine against COVID-19 - patients need only pay the $4.95 shipping and handling fee. It has since ordered the website to shut down the offer.

NY Governor Cuomo announces win against opioid manufacturer

The governor of New York recently announced another legal tool it will use in its fight against the current opioid epidemic. According to Gov. Andrew Cuomo, the state’s Department of Financial Services (DFS) has filed an insurance fraud action against one of the major opioid manufacturers in the area.

Health care fraud in 2020: What will the feds investigate?

The United States Department of Justice (DOJ) recently announced the recovery of over $3 billion in False Claims Act (FCA) violations for health care fraud cases last year. Although this seems like a large number, it is in line with previous years. In fact, this is the tenth year in a row the agency reports recovering more than $2 billion from its work pursuing these cases.

CMS to suspend some, reevaluate other, payment programs

Just a few weeks ago, the United States Centers for Medicare and Medicaid Service (CMS) announced it would allow certain health care providers to receive funds to help maintain financial footing during the coronavirus pandemic. To achieve this goal, the agency expanded its Advance and Accelerated Payment Programs. These programs allow emergency funding in the event of a disruption in claims. The agency expanded the programs to help providers receive much needed funding to cover operational costs during the pandemic.

Why does the CMS’ now require disclosure of certain affiliations?

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.

NY pharmacy owner faces lifetime of prison for health care fraud

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.

Theranos case an example of complex nature of health care crimes

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.

CMS changes tactics, targets health care provider affiliates

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.

Lawmakers remove hospital leader amidst qualification concerns

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.

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