Posts Tagged ‘healthcare fraud defense’
Lessons learned from whistleblower FCA case against cancer treatment company
Earlier this month, the U.S. Department of Justice announced that 21st Century Oncology and its wholly owned subsidiary, South Florida Radiation Oncology LLC, agreed to settle False Claims Act allegations relating to billing for procedures that were medically unnecessary. Specifically, the Fort Myers, Florida-based company was alleged to have billed for performing the Gamma function…
Read MoreSocial media posts can be used to detect healthcare fraud
In George Orwell’s novel Nineteen Eighty-Four, citizens of Oceania, a totalitarian state, are under surveillance at all times and constantly reminded that Big Brother is watching them. Today, with the advancement of digital technologies – from cameras on the street and in stores, to cookies gathered from the Internet – most of us are being watched…
Read MoreHow data mining is uncovering healthcare fraud
What does your data say about your healthcare practice? Does it show that you bill considerably more than your colleagues for certain types of procedures? What about your facility? Is it performing more of a particular procedure than nearby competitors? These days, healthcare fraud investigators increasingly rely on data to root out healthcare fraud. They…
Read MoreFinalized DME rule targets fraud, abuse
The Centers for Medicare and Medicaid Services has finalized a rule that creates a prior authorization process for some durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) that it has determined are often subject to unnecessary utilization – i.e. healthcare fraud. The rule was first proposed in May 2014 and included a Master List of…
Read MoreFeds to increase exclusion and civil monetary penalty enforcement cases
When it comes to exclusion and civil monetary penalty cases, the federal government is preparing to take an even harder line than in the past. During the recent Health Care Compliance Association’s Healthcare Enforcement Compliance Institute, Gregory Demske, chief counsel at the Health and Human Services Office of Inspector General, told an audience his agency…
Read MoreHow whistleblowers are helping to fight healthcare fraud
Earlier this month, the Department of Justice announced it had resolved a $237 million judgment against Toumey Healthcare System in South Carolina for violations of the Stark Law. In this particular case, the hospital was alleged to have entered into contracts with 19 specialists that required them to refer their outpatient procedures to the hospital…
Read MoreHealthcare executives on notice, DOJ cracking down on individuals for corporate misconduct
The federal government has taken a tough stance on healthcare fraud for many years. For the most part, companies caught up in the net have responded by paying huge fines and promising not to engage in fraudulent activities again. Despite the billions of dollars paid out, corporate fraud persists. Now, the feds are turning up…
Read MoreCompounding pharmacies in the eye of investigative storm
In the last year or so there have been a number of stories in the media about investigations into wrongdoing by compounding pharmacies, marketing companies and physicians. At last count there were nearly 100 federal investigations underway for what the feds believe are questionable financial relationships involving these three entities. In some instances, physicians are…
Read MoreCMS’ fraud crackdown relies on high-tech analytics
The government’s crackdown on Medicare fraud is paying off and healthcare providers that bill the government program would be well advised to know that the Centers for Medicare & Medicaid Services is using a high-tech analytics system to identify inappropriate payments. Aptly named the “Fraud Prevention System,†the program has identified or prevented $820 million…
Read MoreFederal prosecutors increasingly target individual healthcare execs in anti-fraud efforts
Last month’s sentencing of the former president and CEO of OtisMed Corporation to two years in prison should serve as yet another example that federal prosecutors are not holding back when it comes to holding corporate executives accountable. Charlie Chi was sentenced for intentionally distributing a medical device used in knee replacement surgery despite the…
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