Info & Intel


Wheeling Hospital Allegedly Paid Millions of Dollars to Physicians in Exchange for Lucrative Referrals

Wheeling Hospital Allegedly Paid Millions of Dollars to Physicians in Exchange for Lucrative Referrals

Wheeling Hospital in West Virginia is facing a federal lawsuit over anti-kickback law violations involving obscene incentives paid to individual physicians, often surpassing $1 million a year.
It is illegal for hospitals to financially entice specialists to refer patients to their facilities. A common practice, nonetheless, this type of kickbacks can help hospitals secure millions of dollars in Medicare and Medicaid reimbursements. The potential earnings are so spectacular, that dishonest...

Louisiana Man Pleads Guilty in Mississippi Medicare Fraud Case Involving Unnecessary Prescriptions

Joseph L. Wiley II, of Monroe, Louisiana, has just pleaded guilty to his participation in a large-scale Mississippi Medicaid and Medicare fraud. Wiley confessed that he helped Mississippi pharmacies submit $400-million worth of fraudulent claims to government health care programs.  
Fraud involving pharmaceutical prescriptions has been rampant in the U.S. over the last decade. Wiley is only a small piece of the puzzle in a scheme that allegedly also involved companies and individuals...

Maryland’s MedStar Health Inc. and Associates Will Pay $35 Million to Settle Medicare Fraud Allegations Involving Kickbacks

MedStar Health Inc. and two hospitals affiliated with it have agreed to pay $35 million to resolve Medicare fraud allegations. According to a lawsuit filed by three cardiac surgeons, between 2006 and 2011, MedStar offered kickbacks to MACVA, a cardiology group based in Maryland, in exchange for lucrative referrals of Medicare beneficiaries. When the referred patients underwent cardiac procedures, MedStar submitted false claims for payment to the Medicare program.
Upon the announcement of...

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...

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