Info & Intel


Face to Face Doctor Visits Required for Narcotics

Face to Face Doctor Visits Required for Narcotics

There has been a tremendous amount of media, public and regulatory attention over America’s opioid crisis. In many areas of the country, the leading cause of death is now drug overdoses. And most of those lethal overdoses involve opioids. Given the attention now given to our so-called opioid epidemic, this post examines the need for face to face doctor visits before these drugs can be dispensed.
The term opioids covers a wide range of narcotics typically used for pain management. In...

Medicaid Fraud and the Vaccines for Children Program

Medicaid Fraud and the Vaccines for Children Program

Since 1994, the federally funded Vaccines For Children program (VFC) has insured that millions of kids from needy families get the lifesaving vaccines they need. The Centers for Disease Control and Prevention says that for kids born between 1994 and 2014, the program will prevent 381,000,000 illnesses and avoid 855,000 deaths.
VFC does this by purchasing vaccines in bulk using tax dollars and then distributing them to all 50 states and selected cities. These local government agencies then...

Medicare Fraud Most Wanted

Medicare Fraud Most Wanted

Do you remember those “Most Wanted” posters from the old movie Westerns? Or the more modern FBI posters in the post office? Well the Inspector General of Health and Human Services has a most wanted list too. Believe it or not, there is a Medicare fraud most wanted list.
The typical Medicare fraudster rips off Medicare by charging for services never rendered or by double billing. Those activities are crimes and since Medicare and Medicaid is funded with tax dollars, these...

Number of Doctors Excluded from Medicare & Medicaid Skyrockets; New Study Will Help Identify Even More Fraudsters

Number of Doctors Excluded from Medicare & Medicaid Skyrockets; New Study Will Help Identify Even More Fraudsters

Fraud is so rampant in the Medicare and Medicaid programs that at times it seems impossible to stop. But a new study shows that the government’s efforts to take down fraudsters are working, and we’re on track to predict and prevent fraud before it starts.
A study from Harvard Medical School and the University of Southern California, published in JAMA Network Open, found that between 2007 and 2017, the number of doctors who were barred from billing Medicare and Medicaid...

ImmediaDent Will Pay $5.1 Million to Settle Medicaid Fraud Allegations

ImmediaDent Will Pay $5.1 Million to Settle Medicaid Fraud Allegations

ImmediaDent and Samson Dental Partners, two licensed Medicaid and Medicare providers, are due to pay $5.1 million to settle claims of fraudulent Medicaid billings. ImmediaDent is the largest dental provider to Medicaid patients in Indiana, Kentucky, and Ohio. Over 40 percent of ImmediaDent’s patients are Medicaid beneficiaries. Samson Dental Partners is a corporation founded in 2003 which operates some ImmediaDent clinics.  
The case was initiated by a whistleblower suit filed...

Durable Medical Equipment-Related Medicare Fraud Costs Florida $58 Million Annually

Durable Medical Equipment-Related Medicare Fraud Costs Florida $58 Million Annually

Recent reports have shed light on the prevalence of Medicaid scams related to Durable Medical Equipment (“DME”).
On the one hand, the enduring nature of DME, which withstands wear and tear, makes it an easy target for illegal profiteering. According to sources from the Tampa Medicare Fraud Strike Force, the state of Florida has become a center for DME fraud. Since 2012, the federal law-enforcement has discovered over DME fraud amounting to $600 million across the nation, with...

From Brain Surgeon to Inmate in Just 6 Months

From Brain Surgeon to Inmate in Just 6 Months

A Michigan surgeon is today serving 19 years and six months in prison after being convicted of criminal Medicaid fraud. In a separate whistleblower action settled last month, Aria Sabit MD also agreed to pay $899,000 to settled civil charges claiming he defrauded Medicare and Medicaid.
Metropolitan Detroit is a Medicaid fraud hotspot. Dr. Sabit’s conviction adds one more to the area’s already grim statistics.
That Sabit was convicted of defrauding Medicaid comes as no...

Health Management Associates Reaches $260 Whistleblower Settlement on Medicare Fraud Charges

Health Management Associates Reaches $260 Whistleblower Settlement on Medicare Fraud Charges

A former national health care company, which was the subject of a scathing 60 Minutes investigation in 2012, is finally facing repercussions for allegedly violating anti-kickback laws; threatening and coercing physicians; and defrauding Medicare, Medicaid and TRICARE.
Health Management Associates (HMA), a hospital chain based in Naples, FL., has reached a $260 million settlement to bring an end to numerous civil and criminal fraud charges. The matter originates from eight separate...

Personal Care Attendant Sentenced for Stealing Money from Elderly Veteran, Medicaid Program

Personal Care Attendant Sentenced for Stealing Money from Elderly Veteran, Medicaid Program

Between one and two million seniors have been abused by caretakers in the U.S. That doesn’t just include neglect or physical abuse; financial abuse is, in fact, the second most common form of elder mistreatment. And, of course, elder abuse is closely tied to Medicaid fraud. A caregiver who is failing to provide a patient with necessary care is likely to lie about it in billing records, too.
Unfortunately, this is exactly what happened in a recent fraud and abuse case in Missouri....

Illinois Pharmacist to Serve up to a Decade in Prison for Medicaid Fraud

Illinois Pharmacist to Serve up to a Decade in Prison for Medicaid Fraud

A Red Bud, IL pharmacist has pleaded guilty to health care fraud charges, admitting that he defrauded Medicare, Medicaid, and private insurers out of more than $630,000. Steven P. Gibson, owner of Gibson’s Discount Drugs at 1506 S. Main Street, will spend up to 10 years in prison for the crime.
Gibson’s scam was simple: he wrote false prescriptions for expensive drugs and submitted them to public and private insurers for reimbursement. The prescriptions were submitted under...

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