The medical profession's first concern should be the welfare of the patient. Most physicians, nurses and other medical professionals go into this field because they share a similar belief. However, as is true in any profession, there are some who stray and find the lure of financial rewards too much to ignore.
What laws govern healthcare fraud and abuse?
The Centers for Medicare and Medicaid Services (CMS) take violations to healthcare laws very seriously. A conviction can come with hefty penalties that may include exclusion from federal healthcare programs, fines and, in severe cases, imprisonment.
Important health care fraud case goes to trial this week
A trial this week involving the once-celebrated Dallas-based Forest Park Medical Center is said to be one of the biggest health care fraud trials in history. There are as many as 150 witnesses as part of the government's case against ten defendants, which include four surgeons and one pain doctor.
Clinical labs: How does a new federal law impact your business?
Lawmakers often pass or change laws with good intentions. In some cases, those intentions may not translate in the real world. An attempt to thwart wrongdoing can result in an unnecessarily confining situation.
Will the HHS find alternative pay an Anti-Kickback violation?
The government is working to transform our healthcare system into one that pays for value. The Health and Human Services Department (HHS) recognizes that care coordination is an important tool to meeting this goal. However, the government has also recognized physicians and other medical professionals abused this system with the use of kickbacks solely intended for financial gain. To thwart such abuse, the government had previously passed Anti-Kickback laws.
Patient sues for Anti-Kickback Statute violation
The False Claims Act is a federal law that allows the government or private individuals to file a claim against those who allegedly make false claims for payment against the United States. It is common for an individual to file suit and the government to join in at a later date. These cases can include physicians and health care providers that charge Medicare or Medicaid for services provided to patients.
Pharmaceutical comp. founder arrested for Anti-Kickback violation
The government recently accused the founder of a pharmaceutical company for illegally conspiring to provide kickbacks to physicians who prescribe the company's medications. The accusations led to the arrest of the entrepreneur. The government based the arrest on evidence the entrepreneur conspired to violate the Anti-Kickback Statute. If convicted, the crime can come with up to five years imprisonment and a monetary fine of $25,000.
Texas physicians group agrees to health care fraud settlement
Texas-based EmCare doctors "provide emergency medicine, hospital medicine, general and trauma surgery, anesthesiology and radiology/teleradiology care to hundreds of hospitals and healthcare facilities throughout the country," the company says on its website. It is perhaps unsurprising that the Dallas firm makes no mention of its recent agreement with the U.S. Department of Justice to settle claims that it engaged in health care fraud.
Drug maker agrees to settle kickback allegations for $210 million
United Therapeutics Corporation (UT), based in Maryland, has just agreed to settle Anti-Kickback Statute and False Claims Act allegations for $210 million. The drug maker has also entered into a five-year corporate integrity agreement with the Department of Health and Human Services Office of Inspector General.
Feds: "White coat" sales scheme violates Anti-Kickback Statute
After Danish multinational pharmaceutical company Novo Nordisk settled claims that it marketed drugs using a "white coat" sales scam, global pharmaceutical competitor Eli Lilly is facing similar charges. A recently unsealed whistleblower lawsuit alleges that Lilly ran a "multi-tiered kickback scheme" to boost sales of insulin drugs.
