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...

Healthcare Fraud Recoveries Top FCA Stats in 2018 at $2.5 Billion

Healthcare Fraud Recoveries Top FCA Stats in 2018 at $2.5 Billion

Last December, the DOJ released its data on False Claims Act (“FCA”) judgments and settlements, which surpassed $2.8 billion for the year. Most of them, 87 percent of the cases filed, were related to healthcare fraud and linked to the Department of Health and Human Services (“HHS”).
Some of the largest recoveries included a settlement with AmerisourceBergen Corporation, which paid $625 million to the government to resolve claims related to their illegal repackaging...

Walgreens Agrees to $60 Million Settlement in New York Medicaid Fraud Case

Walgreens Agrees to $60 Million Settlement in New York Medicaid Fraud Case

In a joint effort with several states and the federal government, the Attorney General reports, the State of New York secured a $60 million settlement to resolve allegations regarding that  Walgreens unlawfully overbilled Medicaid for certain drugs.
The alleged fraud involves Walgreens’ Prescription Savings Club (“PSC”) program. According to prosecutors, the retailer inflated the value of some prescription drugs provided via Medicaid, while it charged much less to...

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...

Arizona Nursing Facility Where Disabled Woman Gave Birth to Baby Boy Has a History of Suspected Health Care Fraud

Arizona Nursing Facility Where Disabled Woman Gave Birth to Baby Boy Has a History of Suspected Health Care Fraud

Hacienda HealthCare, the parent company of numerous Phoenix nursing homes and health care facilities, made headlines when it was revealed that a woman with serious disabilities, who is unable to talk, has limited movement and has been under Hacienda’s care since she was three, gave birth to a baby boy unexpectedly.
This horrific story has prompted criminal charges and a renewed interest in Hacienda’s management (or mismanagement, as it were). The company has been under...

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...

11 Children Died at NJ Rehab Facility; Whistleblower Says Problems Go Much Deeper

11 Children Died at NJ Rehab Facility; Whistleblower Says Problems Go Much Deeper

The Wanaque Center for Nursing and Rehabilitation in Haskell, NJ made headlines for an outbreak of adenovirus that killed 11 children and threatened the lives of dozens of others. According to the facility, the outbreak has been contained and patients are no longer in danger. But based on an ongoing lawsuit, the problems at Wanaque go much deeper, and much further back, than this incident.
Wanaque is a rehab and nursing home known for its pediatric center. The facility has 92 pediatric...

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...

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