The United States Department of Health and Human Services (HHS) recently announced it will invest $6.5 million into two commercial diagnostic labs. The agency has stated it expects the labs, one in Nashville, TN the other in Austin, TX, to use the funds to boost staffing and infrastructure with an ultimate goal of increasing their COVID-19 testing capacities.
As the government continues its crackdown on the opioid crisis, whether or not a pharmacy could find itself the center of a lawsuit for failing to fill an opioid prescription may seem like a surprising question. And yet, that is exactly what three big companies are currently facing. CVS, Walgreens and Costco were all named in a recent lawsuit for not filling opioid prescriptions. The lawsuit claims that because these pharmacy giants failed to fill these prescriptions, patients are unable to continue to manager pain from chronic conditions.
The Department of Justice (DOJ) is continuing its scrutiny of groups that provide Medicare Advantage plans. Just over a year ago, the Office of Inspector General reported that these plans led to billions in risk-adjusted payments that were not supported by specific services provided to patients - ultimately leading to allegations of health care fraud. This report has likely led to increased scrutiny of these programs, as recently highlighted in a case out of Texas.
The United States Centers for Medicare and Medicaid Services (CMS) has set a deadline for providers to begin repaying Accelerated and Advanced Payment Program (APP) loans provided through the Coronavirus Aid, Relief, and Economic Security (CARES) Act. In most cases, the repayment period was set to begin 120 days after the organization received payment. Unfortunately, many medical establishments continue to struggle to meet financial obligations as a result of the coronavirus pandemic.
The United States Department of Justice (DOJ) recently accused a group of 10 individuals of partaking in a health care fraud scheme that cost the government over $1 billion. The accused include hospital executives and diagnostic lab owners as well as billers.
The United States Centers for Medicare and Medicaid Services (CMS) recently released a publication outlining telehealth services that will be eligible for coverage in 2021. The agency’s list includes 39 telehealth-eligible services, such as:
Government authorities recently accused a former surgeon turned business owner of running a criminal enterprise in Texas. The physician transitioned from practicing medicine within the operating room to serving as the owner of an orthopedic and spinal disorder clinic in the Fort Worth area. During his time as a business owner, government authorities state he committed multiple acts of health care fraud.
Hospitals often face allegations of wrongdoing. In some cases, the allegations can be severe and can lead to serious financial penalties as well as criminal liability for individuals that are involved. In one recent example, former employees of a hospital from Tennessee claimed the hospital filed false documents to get money from the government.
The United States Department of Health and Human Services (HHS) issued a rule in November that requires hospitals to disclose the rates they negotiate with insurance providers. The rule requires hospitals begin to provide this information to the public in 2021. In response to the rule, the American Hospital Association, Association of American Medical colleges, Children's Hospital Association and Federation of American Hospitals filed a lawsuit against the HHS, stating the agency did not have the authority to require hospitals to make the disclosure.
The United States Attorney’s Office recently announced a physician has pled guilty to criminal health care fraud charges. The charges are the result of a health care fraud investigation that led to over 15 criminal charges for four medical professionals.