Enforcement Trends: Opioid Crackdown Is Diverting Resources from Traditional OIG Enforcement Activities

The OIG won't admit it, but the opioid crackdown is diverting resources from traditional Medicare fraud and waste enforcement efforts. At least that's the most likely explanation for the dramatic … [Read more...]

OVERPAYMENTS

Rural Hospital Lab Outreach or Fraudulent Overreach?

Case: In February 2017, hospital management firm LifeBrite paid $400K to acquire a bankrupt rural outreach hospital in North Carolina with network status in Blue Cross Blue Shield North Carolina (BC). … [Read more...]

ENFORCEMENT

Opko Health, CEO Named in Pump-and-Dump Stock Fraud Scheme

Case: The U.S. Securities Exchange Commission charged billionaire drug entrepreneur Phillip Frost and his company, Opko Health, for participating in a market manipulation scheme allegedly organized by … [Read more...]

FALSE CLAIMS

Florida Doctor Jailed 5 Months for Lying to a Medicare Auditor

Lying to a Medicare auditor or otherwise obstructing a Medicare audit is a crime that can get you jailed. A 73-year-old endocrinologist specializing in diabetes management just learned that lesson the … [Read more...]

COMPLIANCE TIPS

Surviving a Medicare Audit: Warn Lab Staffers Not to Lie to Auditors

As a lab compliance director, you understand the dangers of obstructing a Medicare audit. The problem is you staff may not. So, make it clear to any staffer that may come into contact with an auditor … [Read more...]

ANTI-KICKBACK

Enforcement Trends: Feds Administer a Double Dose of Civil Monetary Penalty Increases

Potential penalties for Medicare violations will be higher if they're assessed on or after Oct. 11, 2018. That's when the newly announced Dept. of Health and Human Services' (HHS) inflation-adjusted … [Read more...]

ENFORCEMENT

Alabama Hospital and Lab Subsidiary Agree to $4.25 Million Kickback Settlement

Case: Aperian Laboratory Solutions and its parent East Alabama Medical Center will fork over $4.25 million + legal costs to settle charges of paying kickbacks for referrals and then falsely billing … [Read more...]

ANTI-KICKBACK

Michigan Hospital System Pays $84.5 Million for Alleged Billing of Kickback-Induced Services

Case: William Beaumont Hospital has agreed to cough up $84.5 million to settle False Claims Act charges. The case, which began as a qui tam whistleblower lawsuit, contends that the Detroit-based … [Read more...]

FALSE CLAIMS

Dissolution: The Final Act of the Theranos Tragedy

Tragedy was a genre invented by the ancient Greeks to portray the fall of not just ordinary but great individuals. And while "Theranos" is not actually a Greek word (it's actually an amalgamation of … [Read more...]

ENFORCEMENT

Whistleblower Sues Montana Health System Officials for Elaborate Kickback Scheme

Case: The CFO of a Montana hospital physician network filed a qui tam lawsuit against his employer for paying physicians above-market compensation in exchange for referrals to network labs, … [Read more...]


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