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Health Care Investigations Archives

Lab agrees to pay $12 million to settle AKS claim

A diagnostic laboratory recently agreed to pay the government almost $12 million to settle claims that the health care company violated federal Anti-Kickback Statute (AKS) regulations. The government claimed that individuals within the diagnostic lab were illegally bribing health care professionals to use the professional services offered within their lab.

RN gets more than a year imprisonment for health care fraud

Authorities recently announced the sentencing of a registered nurse (RN) to 18 months imprisonment for her role in a health care fraud scheme. As part of the sentence, the court has also required the nurse to pay $9,500 in restitution.

EKRA and COVID-19: What do labs need to know?

The United States Department of Justice (DOJ) and the Office of the Inspector General (OIG) have stated they will aggressively pursue health care fraud claims related to COVID-19. These agencies further clarify that they will continue to focus on prosecution for violations of the Eliminating Kickbacks in Recovery Act (EKRA). The announcement comes at an uncertain time, when diagnostic labs are working to help patients who are waiting for testing while living amidst a global pandemic.

Which court is the right venue for health care disputes?

The answer depends on the details of the allegations. In a recent case, a group of patients filed a class action lawsuit against a New York health system accusing the group of failing to protect their financial, medical and personal information from security leaks. The failure, they allege, resulted in a cyber attack that put the privacy of information like social security numbers in jeopardy.

Avoid these common mistakes when charged with health care fraud

A recent case out of New York provides multiple examples of what not to do if accused of health care fraud. The case began when the U.S. Attorney's Office of the Western District of New York investigated a psychiatric physician for health care fraud. According to the prosecution, the physician billed for the highest level of evaluation appointments when seeing new patients. When questioned about the need for such an inclusive appointment, the government claims he was unable to provide sufficient evidence to support the claim. Upon further investigation, the government claims the physician routinely up coded and improperly billed for services.

Pharmaceutical rep pleads guilty to health care fraud

The United States Attorney’s office recently announced a 50-count indictment charging seven people with health care fraud, wire fraud and other crimes. The charges are the result of alleged abuse of specialty medication prescriptions for compounded medications. One of the charged is a pharmaceutical representative.

AKS violations: A timeline of a typical case

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.

Lab owner sues hospital for breach of contract

Running a lab is a rewarding and difficult profession. In some cases, there are business considerations. Contracts may govern these arrangements. In a recent case, a lab owner accused a hospital of failing to fulfill its agreements as listed within the contract. The case involves a lab owner who went into contract with a large health care system to run a cancer research lab. The lab owner is well known within her field. Lynn Hlatky studied physics and biophysics, receiving a Ph.D. from the University of California, Berkeley. Harvard Medical School recruited the researcher and she joined faculty with the radiation and oncology department after developing a "model for cancer" using physics.

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