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Health Care Investigations Archives

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.”

Link between the college admission scandal and healthcare fraud

The college admission scandal was top of the news headlines just a few weeks ago. The scandal involved members of the Hollywood elite along with other wealthy parents paying bribes to get their children spots in prestigious universities. The fallout of the problem remains to be seen as parents fight allegations in court, colleges sort through admissions to determine the best course of action for their universities and students who were often unknowingly the subject of the scandal attempt to get on with their lives.

Will recent medical lab breaches lead to more audits?

A data breach impacted an estimated 20 million patients from three medical testing labs. The breach was connected to the collection agency used by the lab to manage billing. At this time, it appears the breach occurred for eight months before the lab became aware of the issue.

Manhattan pharmacist accused of $11 million in insurance fraud

An investigation that spanned many months recently resulted in the arrest of a New York-licensed pharmacist accused of running a “medicine-for-case” scam. The Office of the Insurance Fraud Prosecutor recently announced the charges against this and 18 additional individuals allegedly involved in the scam, which allegedly ran from January through August of 2018.

Former state employee sentenced for health care fraud crime

In 2018, the Department of Justice (DOJ) announced charges against a former state employee for health care fraud violations. The accused waived her right to an indictment and chose to take a plea deal. According to the agreement, the accused confessed to running two social and psychotherapy businesses.

Will the billion-dollar fraud case lead to even more charges?

The government recently announced a billion-dollar health care fraud case. The scam allegedly involved sending Medicare recipients shoulder, knee, ankle, wrist and back braces. In most cases, the patients did not need the braces. In others, the patients never received the braces. The companies would then charge Medicare for the cost of the braces, whether patients received them or not. Ultimately, the government states the scheme resulted in a loss of over one billion dollars.

NY labs: New rule goes into effect in October

The Eliminating Kickbacks in Recovery Act of 2018 (EKRA) is a new federal law that applies to diagnostic and clinical labs throughout the country. The law is a part of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT). It takes effect October 24, 2019.

DOJ accuses dozens of doctors of exchanging sex for prescriptions

The United States Department of Justice (DOJ) continues to crackdown on opioid prescription violations. Most recently, the government has accused multiple medical professionals of illegally prescribing these medications in exchange for financial gain and sexual favors.

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