June a busy month for healthcare fraud enforcement

Individual physicians, medical billers, DME manufacturers, healthcare executives and even entire healthcare systems were on the receiving end of the U.S. Department of Health and Human Services Office of the Inspector General’s (OIG) enforcement efforts last month. In fact, there were 39 actions announced by the IG’s office in June, up from 35 in May […]

Genesis Healthcare Settlement Another Example of Government’s Anti-Fraud Campaign

Whatever else is taking place in the nation’s capital these days, one thing is for certain, there is no letup in the government’s crackdown on healthcare fraud. This is made clear by the continued announcements of multimillion-dollar settlements coming from various fraud-fighting agencies. One of the more recent settlements involves Genesis Healthcare, Inc., a Kennett […]

New Corporate Compliance Guidance Issued by DOJ

If you had any doubt that the U.S. Department of Justice had plans to back off its crackdown on healthcare fraud under then new Trump administration, all you need to do is look at its recently released guidance on corporate compliance to understand that it will continue to keep the pressure on. Titled Evaluation of […]

Case of 79-year-old Doctor Illustrates Need for Caution When Accepting Payments

The federal trial of a 79-year-old New Jersey physician charged in connection with a healthcare kickback scheme serves as yet another example of federal prosecutors’ aggressive stance against healthcare fraud and abuse. Dr. Bernard Greenspan is the latest physician to find himself facing jail time. He was among more than 40 people, many of them […]

New Exclusion Rules to Take Effect Next Month

Earlier this month, the Health and Human Services Office of the Inspector General (HHS-OIG) finalized its long-awaited rules on civil monetary penalties that could make it easier for providers to be excluded from participating in the Medicare and Medicaid programs. The final rule, which was published in the Federal Register on January 12, was first […]

The Health Law Offices of Anthony C. Vitale Scores Major Win Against Life Care Centers of America

$145M landmark settlement largest in DOJ history involving skilled nursing facility Oct. 26, 2016 (MIAMI, FLA.) It was a case that was eight years in the making, but on October 24, Anthony C. Vitale’s hard work and dedication paid off when Life Care Centers of America Inc., and its owner Forrest L. Preston, agreed to […]

How can investigators predict healthcare fraud?

Predictive modeling is a term that has been used a great deal lately in the context of healthcare fraud. In a nutshell, predictive modeling is the area of data mining concerned with forecasting probabilities and trends. Here in South Florida, many of us are familiar with its use through the forecasting of hurricanes. In the […]

Feds step-up crackdown on fraudulent billing for compounded meds

The recent indictment of a St. Petersburg physician who was charged with receiving illegal kickbacks for writing prescriptions for compounded medications serves to further highlight the federal government’s increased level of scrutiny over the industry. The facts of the latest case are as follows: Dr. Anthony Baldizzi was charged on June 23 with one count […]

Feds target healthcare fraud by looking for outliers

Last week, the U.S. Department of Justice announced the largest healthcare fraud takedown in its history. Approximately 300 defendants in 36 federal districts, including South Florida, were charged with engaging in fraudulent billings to the tune of more than $900 million. Charges included: conspiracy to commit healthcare fraud, violations of the anti-kickback statutes, money laundering […]

Genetic testing latest scam targeting Tricare

The Tricare program is once again the target of fraudulent claims. The health insurance program for members of the U.S. military, their family and retired military, has been bilked millions of dollars for unnecessary genetic tests and drug screening, according to media reports. The latest alleged Tricare scam goes something like this: Labs set up […]