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.
A paramedic alleges his employer terminated his position because he followed a patient’s request instead of adhering to conventional medical practices. The patient was suffering from a serious infection and asked the paramedic not to move forward with an intraosseous infusion (IO). The procedure, which essentially involves using a drill like device to insert an IV into the patient's bone, would be the conventional practice recommended in this instance. The patient declined treatment. Instead of pushing or forcing the issue, the paramedic honored the patient's wishes.
Zone program integrity contract (ZPIC) audits are on the rise. These audits can result in evidence given to the Department of Health and Human Services (HHS) Office of Inspector General (OIG) and potentially result in criminal charges.
New York Attorney General Letitia James has accused a Long Island pharmacist of a complex, multi-million-dollar Medicaid scam. The scam, according to prosecutors, involved pharmacies throughout New York including locations in Manhattan and the Bronx.
Technology has touched every area of our lives. We have devices in our pockets that allow us to be in constant contact with our loved ones and colleagues, our vehicles are beginning to use the technology needed to drive themselves and our refrigerators can tell us when we need to stop at the grocery store.
The government continues to pursue Insys related healthcare fraud investigations. Insys Therapeutics (Insys), a pharmaceutical giant, is known for manufacturing Subsys, a fentanyl-based spray used for management of severe pain suffered by cancer patients.
The government recently accused a professional counselor of taking part in a complex health care fraud scheme. The prosecution accused the counselor of filing false documents to incorporate the counseling business, completing unnecessary tests of patients receiving treatment at the center and using employed doctor’s medical licenses to fraudulently prescribe and move drugs.
New York State Police recently collaborated with various federal, state and local agencies to conduct an investigation of a transport service accused of defrauding Medicaid. The investigation spanned two years. Upon completion, New York officials arrested thirteen transport drivers. The prosecution has accused the drivers of fraudulently charging the government for their services.
Health care fraud disputes were present throughout 2018. These cases included everything from individual physicians, nurses and other health care professionals fighting boards for their professional licenses to multi-million dollar Anti-Kickback Statute (AKS) violations cases — as discussed in a previous post, available here.
A health care executive known for running nursing and assisted living facilities in Chicago before expanding to Florida will begin trial within the next two weeks. The government has accused the former exec of his role in a scheme that allegedly defrauded Medicare of over $1 billion in false claims. The accused ran approximately 20 facilities and allegedly filed for claims with Medicare for services that were either never provided or unnecessary. The prosecution has also stated the business owner paid illegal kickbacks to physicians to encourage referrals to his facilities.