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January 25, 2019
Healthcare Fraud
What is a Kickback Scheme?
Quite simply, a kickback is an inducement – offering or giving something of value in exchange for getting business referrals. Although that type of behavior can be perfectly legal in some segments of the commercial world, it is not permitted when the business that is being referred is paid for […]
December 17, 2018
Healthcare Fraud
What are Medically Unnecessary Services?
Medical necessity has implications for good, safe patient care and for reimbursement or payment decisions. Although an unnecessary treatment is not always dangerous, it could be used in place of a more appropriate treatment. It could also have side effects or risks that are not justified when the treatment is […]
September 20, 2018
Healthcare Fraud
Common Types of Pharmaceutical Fraud
Pharmacy fraud can take many forms, some of which can be very costly to taxpayers when the pharmaceuticals involved are paid for by government-funded health programs like Medicare or Medicaid. Some of the most common types of pharmacy fraud include: auto-refilling fraud, off-label marketing of drugs, average manufacturer price/best price […]
August 31, 2018
Healthcare Fraud
What are Anti-Kickback Safe Harbors?
The federal Anti-Kickback Statute (“AKS”) imposes penalties on anyone who, knowingly or willfully, offers, pays, solicits, or accepts remuneration in exchange for referrals or payments for goods or services reimbursable under a federal healthcare program.[i] Congress enacted the AKS in 1972, and its primary purpose is “to protect patients and […]
August 20, 2018
Healthcare Fraud
Upcoding Medical Billing
When a provider treats a Medicare patient, the provider must tell Medicare what services were provided so that Medicare can reimburse the doctor the correct amount. Certain services have higher reimbursement amounts than others –a more serious condition will generally be more expensive for the provider to treat and thus, […]
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