The federal government recently accused an orthopedic surgeon from Texas of False Claims Act violations. The health care fraud crimes the physician face allegedly included illegal kickbacks. More specifically, the Department of Justice (DOJ) accused the specialist of taking payouts from OK Compounding in exchange for prescribing on of their medications for a span of approximately two years.
Physicians & health care fraud: 3 FAQs about the False Claims Act
There are certain federal laws that impact a physician no matter where they practice medicine. One example is the False Claims Act (FCA). This law essentially makes it illegal to submit claims for payment from Medicare or Medicaid that the physician knows or should have known was a false or fraudulent claim.
TX case highlights DOJ's $3B in health care fraud winnings
Yes, billions. The Department of Justice (DOJ) continues its crackdown on health care fraud violations in part because it results in large payouts. In 2019, the federal agency reports it recovered over $3 billion from settlements and judgements for False Claims Act violations.
Lawmakers passed this law to hold those accountable who receive payment from government programs based on false pretenses. The agency claims it has recouped an estimated $62 billion since Congress strengthened the False Claims Act in 1986.
Judge sentences hospital owner, doctor to prison for fraud
It is not uncommon for physicians to take a business interest in a health care facility. Such business relationships must be entered into carefully or the physician could face allegations of illegal kickbacks and other criminal violations. A recent case provides an example.
EHR and health care fraud: Vendors, doctors face charges
Software companies marketed electronic health record (EHR) programs as a way to help better ensure quality patient care. In theory, the software would provide accurate, up to date patient records that were readily available to the treating physician. In reality, flaws in some EHR programs led to dangerous errors.
Doctors take note: 3 ways to reduce the risk of a med mal suit
Data shows approximately half of all physicians will face a medical malpractice lawsuit at some point during their professional career. Top causes for a lawsuit include a failure to diagnose an illness or a poor outcome after a medical procedure.
Medical professionals can reduce the risk by taking proactive steps. Three examples include:
What triggers an HHS OIG investigation?
The United States Department of Health and Human Services (HHS) Office of Inspector General (OIG) ensures HHS programs run smoothly. This agency holds those who abuse the program accountable for their wrongdoing by, when necessary, pursuing criminal charges.
CMS to conduct audits, review risk adjustment payments
The United States Department of Health and Human Services Office of Inspector General (OIG) recently released the findings from a study that focused on the Centers for Medicare and Medicaid Services (CMS) provision of unsupported risk adjustment payments. The OIG questioned the CMS' failure to support the risk adjustment payment requests from Medicare Advantage organizations (MAOs) when the MAO failed to provide evidence it conducted a face-to-face appointment to support the requested payment.
Whistleblower lawsuit against neurosurgeons moves forward
Two physicians and an operating room technician filed a whistleblower lawsuit against a group of neurosurgeons and the medical facility where they operated. The whistleblowers accused the medical professionals of falsely inflating the number of spinal surgeries in an effort to increase their earnings and patient referrals. The hospital countered that the practices used were standard throughout the profession. If the whistleblower can support the claim, the allegations result in a violation of the Stark Law and the Anti-Kickback Statute (AKS).
Three things to know about Texas’ new health care billing law
Private practices in Texas must navigate federal, state and local health care regulations. They must stay current and make sure their businesses are in line with any changes to the law. As a result, private practices throughout the state are likely reviewing their billing practices to make sure they are in line with a newly passed law designed by lawmakers to limit surprise billing.
