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.
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.
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.
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.
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.
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.
A Texas cancer centers chain with locations across the Southwest has been embroiled in a years-long legal dispute with an Arkansas competitor. Landmark Cancer Center has locations in San Antonio, Dallas, Plano and other spots in Texas.
Compounding pharmacies can be critical bridges between doctors and patients. The pharmacies make drugs prescribed by physicians for patients with very specific needs that can't be met by commercially available prescriptions. A compounding pharmacy custom-makes drugs from two or more medications so that the patient gets exactly what the doctor ordered.