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Posts tagged "Health Care Investigations"

OIG and coronavirus funds: 2 enforcement efforts in action

The current coronavirus pandemic has led various federal government programs to provide funds to struggling businesses. Some of these funds are set aside specifically for health care businesses. These funds often come with restrictions and improper use can result in fines and allegations of wrongdoing.

Some health care companies return federal funding

The United States Centers for Medicare and Medicaid Services (CMS) sent out federal funding to help qualifying businesses within the health care marketplace. These funds were part of the Coronavirus Aid, Relief and Economic Security Act. In an effort to better ensure medical care providers received the funds promptly, the agency decided to proactively deposit $30 billion to providers who had recently filed claims with Medicare.

CMS rule: A closer look at affiliation reporting for managers

As noted in a previous post, the Centers for Medicare and Medicaid Services (CMS) has a new rule that allows the agency to penalize those who fail to disclose affiliations with those who have had enrollment to Medicare or Medicaid previously revoked or denied.

Rule gives CMS authority to act against affiliates of bad actors

The Centers for Medicare and Medicaid Services (CMS) have a new rule that allows a more proactive approach to enforcement efforts. Lawmakers wrote the rule to provide another tool against health care fraud. According to the Federal Register, the Program Integrity Enhancements to the Provider Enrollment Process, has two main provisions.

Diagnostic lab accused of improper dealings with TX hospitals

The government has strict regulations when it comes to relationships between hospitals and diagnostics labs. These regulations were recently highlighted when the Department of Justice (DOJ) reached a multi-million-dollar settlement with a diagnostic lab over allegations the lab improperly billed federal healthcare programs.

Feds accuse Texas doctor of False Claims Act violation

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.

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.

DOJ charges Texas billing clerk with health care fraud

The United States Department of Justice (DOJ) continues its focus on health care fraud investigations involving National Football League (NFL) players. The agency recently announced another round of criminal charges. As discussed in a recent post, the agency indicted ten players earlier this month for health care fraud crimes. This round of criminal charges involves a billing clerk that was allegedly affiliated with a health care fraud scheme that involved another, former NFL player.

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