Archive
Former Indiana surgeon nabbed in Italy gets 7 years in prison
A former Indiana surgeon arrested on a snowy Italian mountainside after five years on the run was handed a stiff prison term Friday for billing insurers and patients for procedures he didn’t perform, with the federal judge saying he used patients like an ATM machine.
See on www.foxnews.com
USDOJ: Medicare Fraud Strike Force Charges 91 Individuals for Approximately $430 Million in False Billing
Medicare Fraud Strike Force operations in seven cities have led to charges against 91 individuals – including doctors, nurses and other licensed medical professionals – for their alleged participation in Medicare fraud schemes involving approximately $429.2 million in false billing, Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius announced today.
Attorney General Holder and Secretary Sebelius were joined in the announcement of the nationwide takedown by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division, FBI Associate Deputy Director Kevin Perkins, Inspector General Daniel R. Levinson of the HHS Office of Inspector General (HHS-OIG) and Dr. Peter Budetti, Deputy Administrator for Program Integrity of the Centers for Medicare and Medicaid Services (CMS).
“Today’s enforcement actions reveal an alarming and unacceptable trend of individuals attempting to exploit federal health care programs to steal billions in taxpayer dollars for personal gain,” said Attorney General Holder. “Such activities not only siphon precious taxpayer resources, drive up health care costs, and jeopardize the strength of the Medicare program – they also disproportionately victimize the most vulnerable members of society, including elderly, disabled and impoverished Americans.”
“Today’s arrests put criminals on notice that we are cracking down hard on people who want to steal from Medicare,” said HHS Secretary Sebelius. “The health care law gives us new tools to better fight fraud and make Medicare stronger. In addition to the arrests made today, HHS used new authority from the health care law to stop future payments to many of the health care providers suspected of fraud, saving Medicare resources and taxpayer dollars from being lost to fraud in the first place.”
See on www.justice.gov
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Manoj Jain: Doctors need to eliminate waste from healthcare — Memphis Commercial Appeal
Dr. Manoj Jain is an infectious disease physician and also writes for The Washington Post. His articles can be seen on MJainMD.com.
Thirty percent of health care spending — amounting to $750 billion a year — is wasted, according to a recent report by the Institute of Medicine.
I know. As a doctor, I am party to this waste, and I think doctors can play a major role in recovering it.
In a private conversation, a cardiologist tells me about his partners — “loose guns” he calls them. “At the hint of chest pain they will do a cardiac cath and this makes everyone happy,” he says. The patient feels good that something was done, the doctor gains certainty of his presumptive diagnosis and the hospital makes money. While it may seem like a win-win-win, in fact, we all lose as the health care expenditure tops $2 trillion, siphoning funds from education, housing and business innovation.
The IOM report notes that unnecessary services are responsible for nearly a third, or $210 billion, of wasted expenditure.
I, too, order excessive services like CT and MRI scans, without regard to cost. Often these services are in the gray zone of medicine where it is unclear if some procedures are really necessary.
When we doctors talk about waste, we often beat around the bush. We know the system is full of waste, but when confronted we blame the patients or malpractice attorneys.
There is another less-talked-about reason for unnecessary services. One person’s waste is another person’s income. Another cardiac catherization, another back surgery means more income for doctors, hospitals and the health care system and its archaic administrative services.
To reduce waste, doctors need to become integral partners in the cost-cutting process.
See on www.commercialappeal.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Louisiana Couple sentenced in Medicare fraud case
A Plaquemine couple is headed to federal prison after admitting that they used their medical equipment company to defraud Medicare of slightly more than $1 million.
The couple admitted they billed Medicare for equipment that was either medically unnecessary or never delivered to Medicare beneficiaries. In some cases, Medicare was billed for expensive equipment for which inferior products were substituted.
Between January 2006 and March 2008, according to their charge, the Stewarts and “others known and unknown to the United States attorney” falsely billed Medicare for $1.9 million in power wheelchairs, orthotics and other durable medical equipment.
See on www.fox8live.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
ID theft scammers pretend to be Medicare reps, offer free medical supplies to get information – The Prescott Daily Courier – Prescott, Arizona
Prescott, AZ: Better Business Bureaus across the country have received calls from seniors being targeted for Medicare fraud, said Mary Hawkes, director of the BBB Yavapai County office.
“Seniors in northern Arizona report receiving calls from individuals claiming to be with Medicare offering free items such as a back brace and diabetic supplies in exchange for consumers’ financial and personal information,” Hawkes said, “Due to the high likelihood that callers are not associated with Medicare, the Better Business Bureau is alerting the senior community to be wary of calls offering Medicare benefits.”
Local seniors said after the caller identifies himself or herself as a representative from Medicare, he or she offers free items to entice consumers to provide their Medicare number, as well as insurance and personal information.
See on www.dcourier.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Medical Holocaust Blogpost: Florida, HCA, Rick Scott and Medicare Fraud
Some strong opinions and YouTube videos from the Medical Holocaust Blogpost:
“Rick Scott is just one of many corporate gangsters operating in the lucrative and largely unregulated medical industry. Now street level thugs in Florida have taken a lesson form guys like Rick Scott and are bilking Medicare for billions. Rick Scott wins the gold medal when it comes to bilking Medicare and private insurance out of billions and his gold medal performance has inspired other criminals of a slightly different pedigree to follow in his footsteps.”
See on medicalholocaust.blogspot.fr
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
A Harsh Reminder of How Active the OIG, DOJ, and State AGs are in Health Fraud Prevention
A harsh reminder to healthcare providers that the OIG, DOJ, and state AGs are actively prosecuting healthcare fraud.
See on oig.hhs.gov
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
USDOJ: Hospital Chain HCA Inc. Pays $16.5 Million to Settle False Claims Act Allegations Regarding Chattanooga, Tenn., Hospital
HCA Inc., one of the nation’s largest for-profit hospital chains, has agreed to pay the United States and the state of Tennessee $16.5 million to settle claims that it violated the False Claims Act and the Stark Statute, the Department of Justice announced today.
As alleged in the settlement agreement, during 2007, HCA, through its subsidiaries Parkridge Medical Center, located in Chattanooga, Tenn., and HCA Physician Services (HCAPS), headquartered in Nashville, Tenn., entered into a series of financial transactions with a physician group, Diagnostic Associates of Chattanooga, through which it provided financial benefits intended to induce the physician members of Diagnostic to refer patients to HCA facilities. These financial transactions included rental payments for office space leased from Diagnostic at a rate well in excess of fair market value in order to assist Diagnostic members to meet their mortgage obligations and a release of Diagnostic members from a separate lease obligation.
The Stark Statute restricts financial relationships that hospitals may enter into with physicians who potentially may refer patients to them. Federal law prohibits the payment of medical claims that result from such prohibited relationships.
“The Department of Justice continues to pursue cases involving improper financial relationships between health care providers and their referral sources, because such relationships can corrupt a physician’s judgment about the patient’s true healthcare needs,” said Stuart F. Delery, the Acting Assistant Attorney General for the Department of Justice’s Civil Division.
“Physicians should make decisions regarding referrals to health care facilities based on what is in the best interest of patients without being induced by payments from hospitals competing for their business,” said Bill Killian, U.S. Attorney for the Eastern District of Tennessee.
“Improper business deals between hospitals and physicians jeopardize both patient care and federal program dollars,” said Daniel R. Levinson, Inspector General of the Department of Health and Human Services. “Our investigators continue to work shoulder to shoulder with other law enforcement authorities to stop schemes that imperil scarce health care resources.”
See on www.justice.gov
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
USDOJ: US Attorney’s Office New Jersey – Fifth New Jersey Health Care Practitioner Pleads Guilty In Cash-For-Patients Scheme
NEWARK, N.J. – Dinesh Patel, a New Jersey doctor practicing in Newark, pleaded guilty today to participating in a cash-for-patients scheme with a diagnostic facility in Orange, N.J., and agreed to pay back thousands of dollars in bribe money he received in the past two years, U.S. Attorney Paul J. Fishman announced.
Patel, 58, of Livingston, N.J., pleaded guilty today before U.S. District Judge Claire C. Cecchi to an Information charging him with one count of violating the federal healthcare program anti-kickback statute. Patel will forfeit $7,600 he received in kickbacks during the years 2010 and 2011.
According to documents filed in this case and statements made in court:
On Dec.13, 2011, Patel was arrested and charged with accepting cash kickback payments from Orange Community MRI (“Orange MRI”), a diagnostic facility, in exchange for his referral of Medicare and Medicaid patients. Also on Dec. 13, 2011, 12 other New Jersey doctors and one nurse practitioner were arrested and charged in separate complaints with accepting similar cash kickback payments from Orange MRI. As revealed in the Complaints, each of the defendants were recorded taking envelopes of cash in exchange for patient referrals. On Dec. 8, 2011, an Orange MRI executive was arrested and charged in a separate Complaint in connection with his participation in the scheme.
Patel is the fifth person arrested in the December 13 takedown to plead guilty. In all, the five defendants who have pleaded guilty thus far accepted nearly $150,000 in illegal kickbacks from Orange MRI.
See on www.justice.gov
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
USDOJ: Five Individuals Charged in Detroit for Alleged Roles in $24.7 Million Medicare Fraud Scheme
WASHINGTON – Five individuals were charged in court documents unsealed today in the Eastern District of Michigan for their participation in a Medicare fraud scheme involving purported home health and psychotherapy services, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).
According to court documents, the scheme allegedly involved a total of more than $24.7 million in fraudulent claims submitted to Medicare for purported home health care and psychotherapy services that were medically unnecessary and/or never provided.
Court documents allege that the defendants are operators, employees and marketers associated with home health care and psychotherapy clinics operating in and around Detroit. Defendants charged in court documents unsealed today include: Mohammed Sadiq, 65, Troy, Mich.; Jamella Al-Jumail, 23, of Brownstown, Mich.; Firas Alky, 40, of Shelby Township, Mich.; Clarence Cooper, 53, of Detroit; and Beverly Cooper, 58, of Detroit.
Four defendants charged in the superseding indictment were previously charged and arrested in May 2012 for their roles in the scheme. Defendants previously charged include: Sachin Sharma, 36, of Shelby Township; Dana Sharma, 29, of Shelby Township; Abdul Malik Al-Jumail, aka Tony, 52, of Brownstown; Felicar Williams, 49, of Dearborn, Mich.
See on www.justice.gov
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Joseph Rugg's Health Law Blog 