By Mary Inman, Esq. and Max Voldman, Esq.
The government has been cracking down on pharmaceutical companies’ nefarious use of charities to steer Medicare patients toward more expensive drugs, costing taxpayers millions of dollars. The schemes take a few forms, but the fact pattern generally goes something like this: a pharmaceutical company sets up a charity (or makes…
August 6, 2020
By Sean M. Weiss, CEMA, CMCO, CPMA, CPC-P, CMPE, CMPM, CPC-P Feds Recover More Than $3.5 Billion in FY 2019
Information is provided in a breakdown of the annual HHS-DOJ fiscal report. On July 27, the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Justice (DOJ) issued the healthcare fraud and abuse control program annual report for the 2019 fiscal year (FY 2019). This report…
By Mary Inman, Esq. and Max Voldman, Esq.
Allegations were made of kickbacks in the form of co-pay waivers. Late last month, US WorldMeds, a pharmaceutical manufacturer, agreed to pay the U.S. Department of Justice (DOJ) $17.5 million to resolve two whistleblowers’ claims that it violated the False Claims Act (FCA) by paying kickbacks to patients and doctors…
January 24, 2019
By Mary Inman, Esq. Intermountain Healthcare Seeks to Dismantle the DOJ’s Chief Civil Fraud Enforcement Tool
Lawsuits initiated by whistleblowers under the False Claims Act. Last Wednesday, in a petition to the United States Supreme Court, Intermountain Healthcare (Intermountain), the largest healthcare provider in the Intermountain U.S., made headline legal news by challenging the constitutionality of the False Claims Act (FCA), one of the government’s most…
November 15, 2018
By David M. Glaser, Esq. Mixed Messaging from DOJ at HCCA Conference for Second Straight Year
Federal officials seem wary about their words and their dissemination. At the Health Care Compliance Association’s (HCCA’s) fourth annual Healthcare Enforcement Compliance Conference, top U.S. Department of Justice (DOJ) officials provided an update on current developments related to criminal and civil fraud investigations. While a future article will focus on…
July 19, 2018
By Mary Inman, Esq. and Max Voldman, Esq. Hundreds of Medical Professionals Charged in Largest Healthcare Fraud Takedown in American History
Federal takedown is considered the largest healthcare fraud in history. The Department of Justice (DOJ) has charged hundreds of medical professionals in what was dubbed “the largest healthcare fraud takedown operation in American history.” The DOJ brought charges against 601 defendants (76 of whom are doctors) for their alleged participation…
By Ronald Hirsch, MD
If this hospital was targeted by the DOJ, where does that leave everyone else? Today I have a great mystery to present. Last week the U.S. Department of Justice (DOJ) announced a $1.88 million False Claims Act settlement with Genesis Medical Center in Davenport, Iowa. In the settlement, the DOJ…
By Mary Inman, Esq. and Max Voldman, Esq.
The DOJ has focused particularly on the payment of kickbacks that induce physicians to prescribe more, or more expensive, opioids. Last week, President Trump unveiled the administration’s new plan to combat the opioid epidemic. In 2016, more than 11 million Americans misused prescription opioids, resulting in 42,000 related deaths and…
March 22, 2018
By David M. Glaser, Esq. Modifier 25: Chose Wisely from Three Options
Whatever you do, don’t bring patients back for a procedure another day just for the purposes of billing. Determining when to use Modifier 25 can be challenging, and reasonable people can differ about whether it is appropriate in a particular situation. When a patient needs a procedure on the day…
March 8, 2018
By Mary Inman, Esq. and Max Voldman, Esq. Case Against UnitedHealth Group for Alleged Inflation of Part C Risk Scores is Permitted to Proceed
Recent press coverage misleadingly suggested that the ruling was a serious setback to the government’s suit, which is not the case. On Feb. 12, 2018, a federal judge in the Central District of California issued his ruling on the UnitedHealth Group’s (UHG) motion to dismiss the government’s complaint in one…
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