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Health Care Investigations Archives

DEA suspends pharmaceutical company’s registration

The United States Drug Enforcement Administration (DEA) recently suspended the license of a pharmaceutical company amidst allegations of suspicious orders for controlled substances. The DEA stated that the suspension was due to a determination that continued operation of the business would “constitute a substantial likelihood of imminent danger to public health and safety.”

Texas radiotherapy center ends 5 year investigation by DOJ

SightLine Health LLC, a Texas radiotherapy center, recently took steps to end an ongoing investigation by the Department of Justice (DOJ). The DOJ was looking into allegations that the practice violated the Anti-Kickback Statute when it offered financial incentives to other medical practitioners in exchange for patient referrals.

Ambulance provider settles fraud claim

Emergency Medical Services Alliance (EMSA) recently agreed to settle a claim based on allegations of Medicare fraud. Federal officials claimed that the ambulance service provider was submitting false claims for compensation from Medicare and Medicaid. This allegedly resulted in over $109 million in fraudulent payments.

Texas family loses ranch in healthcare fraud case

A family operation faced accusations of healthcare fraud in Dallas. The operation, Anderson Optical & Hearing Aids Center, allegedly defrauded Blue Cross Blue Shield of Texas of over $16.7 million. A father and son run the facility. The father was convicted on 15 counts for healthcare fraud and identity theft. The son, 13 counts for the same crimes.

Legal advocacy is necessary when a medical investigation beckons

It is understandable that health care professionals and health care providers are under constant scrutiny for the service and work they provide. Medical care is highly specialized, and any mistake or issue that may arise could lead to serious complications for patients. But at the same time, medical professionals need to be protected from frivolous or otherwise unnecessary claims of malpractice, substandard care, or other violations of the law.

Federal regulators step up enforcement at nursing homes

The Nursing Home Reform Law of 1987 states that a nursing home facility is not allowed to transfer or discharge a resident unless it can establish certain criteria. This law was passed as a result of complaints by residents throughout the country about evictions.

Scripps Health settles unauthorized claims case for $1.5 million

Scripps Health, a health care system based in San Diego, has agreed to settle federal False Claims Act allegations for $1.5 million. The Department of Justice accused the system of allowing unauthorized physical therapists to bill Medicare and TRICARE.

Can technology end Medicare fraud?

The Office of Inspector General recently issued a report card for the Department of Health and Human Services. It said that while HHS met many of the requirements in a 2002 law to curb improper payments, it did not fully comply for fiscal 2016. The Inspector General urges HHS to renew its focus on feasible ways to drive the rate of improper payments below 10 percent.

Bounty hunters wreaking havoc

A recent article in a home health care industry publication lays out a compelling argument against a bounty system that punishes individuals and companies that have done nothing wrong. Their "crimes" are often little more than bookkeeping errors, insufficient documentation or simply being in the wrong place at the wrong time and getting pulled into one of many investigations launched in pursuit of big paydays from whistleblower lawsuits.

Feds: Medicare, Medicaid fraud risk assessment needed

In a fact sheet released last year, the Obama administration touted its efforts in "reducing fraud, waste, and abuse across the government." But many observers believe the federal government still isn't doing enough to prevent fraud in Medicare and Medicaid.

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