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Health Care Investigations Archives

3 lessons after health care exec gets 20 for health care fraud

A United States district judge recently sentenced a health care executive after the government accused him of running an elaborate network that benefited from the use of illegal referrals. According to the indictment, the accused owned and operated skilled nursing facilities and assisted living facilities. The government accused the businessman of using illegal bribes and kickbacks to encourage medical professionals to recommend the use of his businesses to patients.

DOJ charges 30 in "patients for cash" health care fraud scheme

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.

CMS announces increased health care fraud enforcement measures

The United States Centers for Medicare and Medicaid Services (CMS) recently announced a new rule to address health care fraud. The announcement was made in September 2019. The new rule expands the agency’s ability to revoke or deny applications for entry or re-enrollment into the Medicare, Medicaid and CHIP payment programs.

Tips for an effective voluntary health care compliance program

The government requires medical facilities to follow certain rules and regulations. A failure to do so can result in allegations of wrongdoing. One specific area that can cause great harm to a health care facility are allegations of health care fraud. If substantiated, the allegations can come with crippling financial penalties and potentially result in the inability to continue to bill for services through Medicare and Medicaid.

Lessons from government investigation of UNC Hospital

Any number of events can trigger a government investigation of a medical facility. The government may receive an anonymous tip, billing practices may lead to a red flag or, as recently highlighted in a case involving the University of North Carolina's (UNC) Congenital Heart Program, negative publicity can snowball and fuel a closer look by government officials.

Feds accuse NY doc of taking illegal kickbacks: 3 things to know

The federal government recently accused a New York doctor of partaking in a health care fraud scheme that spanned throughout the country. The alleged scheme involved prescriptions for a pain cream in exchange for illegal kickbacks from a pharmacy located in Oklahoma.

NY endocrinologist accused of health care fraud

A recent case out of New York highlights the government's continued crack down on opioid prescription abuse. The case involves an endocrinologist with offices in the Bronx and Yonkers. State officials accused the medical professional of prescribing over 50,000 oxycodone pills to a single patient over a span of five years.

Look-back period extended for some Medicare overpayments

The Office of the Inspector General (OIG) recently conducted an audit of Medicare claims for a specific medical device. The agency found the majority of Medicare claims for this device, the positive airway pressure device and associated supplies, did not comply with Medicare requirements. As a result, the agency called on those who filed claims with Medicare for payment for these devices to “exercise reasonable due diligence to investigate and return any identified overpayments, in accordance with the 60-day rule.”

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