July 22, 2015
Medicaid Fraud
With one of the most active and often-used state False Claims Acts, New York has once again taken aim at alleged misconduct within the healthcare industry. According to a recent announcement by the New York Attorney General’s Office, the popular Walgreens pharmacy and its subsidiary Trinity Homecare, LLC have reached […]
July 21, 2015
Healthcare Fraud
In yesterday’s post, we introduced the concept of risk assessment scores, and how the Center for Medicaid and Medicare Services (CMS) relies on information reported by healthcare facilities to adjust reimbursement rates [1. Medicare Managed Care Manual, Chapter 7. http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/mc86c07.pdf] for certain demographics and regional areas. As a review, certain […]
July 20, 2015
Healthcare Fraud
According to a report published by the Center for Public Integrity, as many as six separate whistleblower lawsuits have been filed since 2010 alleging inflated ‘risk adjustment scores’ submitted to the Center for Medicare and Medicaid Services (CMS). This paradigm shift in alleging false claims centers on the notion that […]
July 17, 2015
Healthcare Fraud
As a healthcare practitioner, permission to work with Medicaid and Medicare participants can be an extremely lucrative area of practice. For many physicians working in areas with an aging or low-income demographic, government healthcare enrollees can quickly become a large majority of the patient load – which can often invite […]
July 15, 2015
Contractor Fraud
In today’s post, we explore a form of trickery involving underpayment of workers tasked with constructing federally-funded housing in the Milwaukee, Wisconsin, area. Watry Homes, LLC, has settled both civil and criminal charges stemming from a massive payroll fraud scheme costing taxpayers millions of dollars and resulting in the extreme […]
July 6, 2015
Healthcare Fraud
In today’s post, we will explore a recent $105,000 settlement involving a Tulsa, Oklahoma, physician accused of defrauding the taxpayer-funded Medicare system, which serves millions of Americans aged 65 and older with affordable health insurance coverage.[1. Department of Justice Press Release, “Settlement Reached In Medicare Fraud Lawsuit Against Tulsa Doctor And […]
July 3, 2015
Healthcare Fraud
The Riverside General Hospital first opened its doors in the 1960s amid a torrent racial climate, becoming one of the first hospitals to de-segregate and operate on policies of inclusion and equality. Since then, it has faced untold financial struggles, including a recent indictment stemming from allegations of nine-figure financial […]
July 2, 2015
Healthcare Fraud
Florida is one of the top retirement havens in the United States. Accordingly, it is one of just a handful of areas specifically targeted by Medicare fraud task forces, as the potential for scams and misconduct is congruently heightened by the increasing elderly population. In today’s post, we review a […]
July 1, 2015
Healthcare Fraud
In a recent settlement between the Department of Justice and a Florida cosmetic surgeon, the latter has agreed to pay $4 million to settle expansive allegations of Medicare fraud.[1. Department of Justice Press Release, “Florida Physician Agrees to Pay $4 Million and To Accept a 5-Year Exclusion From Medicare to Resolve […]
June 30, 2015
Healthcare Fraud
When reimbursing for prescription medication, agencies like Medicare and Medicaid are only permitted to pay claims for drugs that are prescribed for their approved use. When a doctor or pharmaceutical company prescribes or promotes a drug for an unapproved use, subsequent invoices for reimbursement could trigger False Claims Act liability.
June 29, 2015
Healthcare Fraud
In a small but mighty settlement against an experienced Connecticut physician, the Department of Justice recently exposed significant fraud and upcoding schemes within a Ridgefield office specializing in geriatric care. The physician, who has been practicing medicine for over 40 years, is alleged to have instructed his staff and billing […]
June 24, 2015
Healthcare Fraud
Following a lengthy False Claims Act investigation by the Department of Justice and Department of Health and Human Services, a New Jersey health network has agreed to pay $3.6 million to settle allegations it unlawfully billed Medicare and Medicaid for various unnecessary or underperformed procedures. Healthcare providers are only permitted […]