Info & Intel

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...

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...

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...

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...

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...

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...

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...

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...