May 1, 2012

McKesson on the Hook for $190 million; Fraud in the News

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alert-powered-by-decision-health

 

Large drug wholesaler McKesson Corporation will pay more than $190 million to resolve false claims allegations that the company inflated drug price information.

That information was used to set rates for pharmaceuticals by Medicaid and other programs, the Justice Department stated in an April 26 announcement. McKesson marked up prices and caused First DataBank to publish inflated average wholesale prices for those drugs.

In other fraud news:

Three operators of a Miami home health agency will spend between seven and 10 years in prison after pleading guilty in connection with a $60 million Medicare fraud scheme, the Justice Department reported April 25. The three paid kickbacks and bribes to patient recruiters and billed Medicare for unnecessary nursing and therapy services. Along with the prison time, they will have to pay $40 million in restitution.

A New Jersey man posing as a doctor will spend four years in prison after conducting hundreds of visits to elderly, homebound patients then billing Medicare, the Justice Department stated April 23. The man used names and identification numbers of licensed professionals who had worked for him at the Visiting Doctors of New Jersey but quit when he didn't pay them. He will have to pay $40,000 in restitution and undergo alcohol/drug/mental health/gambling treatment.

One RAC Issue Posted

The Region A recovery auditor (RAC) DCS Healthcare Services posted one issue April 26 for semi-automated review of inpatient rehabilitation facility patient assessment data.

Note: DCS' post had two suspected typos - the issue name mentioned the late submission of IRF-PAI date, though the description indicated the RAC was targeting late data. Also, one of the states listed was RH, though it's assumed the RAC target affects Rhode Island. (Those have been corrected in the chart below.)

Inpatient rehabilitation facilities

Name of issue

Date posted or approved

Regions/states where it is active

Description of issue

Document sources

Late submissions of inpatient rehabilitation facility patient-assessment instrument data

4/26/12

Maine, Mass., N.H., R.I., Vt.

Inpatient rehabilitation facility-patient assessment instrument (IRF-PAI) data, which is collected on a Medicare Part A fee-for-service inpatient, must be transmitted to the CMS National Assessment Collection Database by the 17th calendar day from the date of the patient's discharge. Transmission of the IRF-PAI data record 28 or more calendar days after the discharge date, with the discharge date itself starting the counting sequence, will result in the claim incurring a 25 percent late-transmission penalty.

Medicare Claims Processing Manual chapter 3; MLN Matters article MM3885; OIG report A-01-09-00507

 

About the Author

Karen Long is the compliance product manager for DecisionHealth and oversees products that relate to fraud and abuse and HIPAA compliance for physician offices and home health agencies, and accreditation compliance for hospitals. In her almost four years at DecisionHealth, Karen also has been the compliance editor and a reporter for Home Health Line, nation's leading independent authority on home healthcare business, regulation and reimbursement.

Contact the Author

KLong@decisionhealth.com

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Karen Long

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