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Health Care Investigations Archives

Texas physicians sentenced to prison for Medicare Fraud

The government built two successful cases against Texas physicians to start the New Year. The Justice Department’s Criminal Division along with the United States Department of Health and Human Services Office of the Inspector General (HHS-OIG) Dallas Region recently announced the sentences for the accused medical professionals.

Retail giant settles Medicare fraud case

The Office of Inspector General (OIG) for the United States Department of Health and Human Services (HHS) has required pharmacy giant Walgreen's to partake in a Corporate Integrity Agreement. The agreement requires the retail store and pharmacy to agree to broad oversight and reviews to ensure it is following requirements when involved in federal programs.

Company closes after Medicare stops covering diagnostic test

Coverage by medical insurance is important for more than just patients—it is also important for those who operate in the health care industry. Businesses that operate in this market often depend on payments from insurance companies to continue operations. Without payment for the services provided, the business may not receive the funds it needs to operate.

HHS makes headway on Medicare reimbursement appeal backlog

The Recovery Audit Contractor Program is one group that contracts with the government ot correct inaccurate Medicare payments. Those who disagree with the program’s findings can appeal the process. However, one of the biggest critiques of the appeals process is the length of time it takes to reach a resolution. As of February 2015, the appeals process took an average of 572 days.

TX city official sentenced to 2 years for health care fraud

The Southern District of Texas recently accused a Texas pharmacy owner of an elaborate health care fraud scheme. During the investigation, the prosecution gathered evidence to support allegations a city official was also involved in the scheme. The accusations were serious and included involvement in an alleged scheme to receive over $1.7 million in false payments from Blue Cross and Blue Shield of Texas.

Did a TX hospital commit a crime by failing to release patients?

Psychiatric facilities must operate while maintaining a difficult balance: provide the care patients need while not discharging them at a time they could injure themselves or others. A failure to navigate this balance wisely can result in allegations of criminal wrongdoing.

Insurance company demands TX hospital return $1 million

Navigating the intricacies of insurance payments is difficult, even for hospital officials. One local hospital is attempting to figure out what went wrong that led to an insurance company accusing the hospital of fraudulent billing practices.

Texas doctor faces seven years in prison for fraud

The Department of Justice continues to crack down on allegations of bribery in the healthcare industry. In the latest case, the government accused a Texas surgeon of paying and receiving bribes in relation to his medical practice.

How will the SUPPORT Act impact medical professionals?

Lawmakers recently passed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) Act. This proposal passed with bipartisan support and was signed into law by President Donald Trump on October 24, 2018. The SUPPORT Act will have a major impact on healthcare throughout the country.

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