The federal government has been busy since the beginning of the year announcing arrests, convictions and settlements relating to healthcare fraud and abuse. The activities relate to violations of the Stark Law, anti-kickback law and federal False Claims Act, and there appears to be no end in sight. Whether it’s home health, transportation, durable medical…

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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…

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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…

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It’s no secret that in recent years the number of healthcare fraud investigations and prosecutions in the U.S. has rocketed. Clearly, the amount of taxpayer dollars being lost to fraud and abuse, coupled with the potential for big payoffs when fraud is detected, is a great motivator. Every year that the government racks up successful…

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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…

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