Physicians convicted of Medicare/Medicaid Fraud face heavier sentence

2-1-15 A recent case in the Third Circuit, which includes Pennsylvania, New Jersey and Delaware, has increased the sentencing exposure of physicians who have been convicted of Medicare/Medicaid fraud. In United States v. Babaria, 14-2694 (3d Cir. 12-31-14), the Court held that a physician who was the medical director of a diagnostic testing and imaging company abused […]

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Christmas Gifts and Scrouge

December 4, ’14 Small health care providers should be careful being nice to their patients and clients this time of the year! Whether you run a home health care agency, a durable medical equipment company, an ambulance company,  a small pharmacy or have a small medical practice, whatever you do, don’t give a Christmas present […]

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OIG’s Work Plan for 2015

The Office of Inspector General (OIG) has published its Work Plan for Fiscal Year 2015 which describes OIG’s investigative priorities for 2015. The small health care provider needs to be familiar with the Work Plan to avoid coming up on OIG’s investigative radar. With respect to Medicare Parts A, B, & D, OIG’s investigations will focus on: hospital outlier payments; […]

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Small health care providers are under attack by overzealous prosecutors

Monday, October 13, 2014 Small health care providers are under attack by overzealous prosecutors who use non-health care fraud-related statutes to drastically increase the sentencing exposure of providers who have been indicted for garden-variety Medicare fraud. One such case arose in Philadelphia recently where a podiatrist was charged with billing Medicare for $480,000 worth of […]

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If you, the small health care provider, are accused of Medicare or Medicaid fraud, tell the government even the States over-bill for Medicaid services!

Wednesday, October 1, 2014 If you, the small health care provider, are accused of Medicare or Medicaid fraud, tell the government even the States over-bill for Medicaid services! By way of background, the Medicaid program provides assistance to certain low-income and disabled individuals. The Federal and State governments jointly fund and administer the Medicaid program. […]

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The government uses a variety of criminal statutes to prosecute health care fraud and abuse

Friday, September 26, 2014 The government uses a variety of criminal statutes to prosecute health care fraud and abuse in addition to the more traditional ones such as the Anti-Kickback Statute and the Health Care Fraud Statute. The government does this oftentimes in an effort to increase the defendant’s sentencing exposure. In a September 25, […]

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Pharmaceutical manufacturers … may run afoul of the Anti-Kickback statute

Friday, September 19, 2014 Pharmaceutical manufacturers who offer copayment coupons to insured patients to reduce or eliminate the cost of their out-of-pocket copayments for specific brand-name drugs may run afoul of the Anti-Kickback statute, says the OIG in a September 2014 Special Advisory Bulletin. http://oig.hhs.gov/fraud/docs/alertsandbulletins/2014/SAB_Copayment_Coupons.pdf. The anti-kickback statute makes it a criminal offense to knowingly […]

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OIG has published an on-line pamphlet called “A Roadmap for New Physicians, Avoiding Medicare and Medicaid Fraud and Abuse.”

Thursday, September 18, 2014 OIG has published an on-line pamphlet called “A Roadmap for New Physicians, Avoiding Medicare and Medicaid Fraud and Abuse.” http://oig.hhs.gov/compliance/physician-education/roadmap_web_version.pdf. In it, the OIG provides physicians with an overview of the five primary health care fraud and abuse laws: (1) False Claims Act; (2) Anti-Kickback Statute; (3) Physician Self-Referral (“Stark”) Law; […]

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OIG is stepping up audits of small health care providers who bill Medicare.

Tuesday, September 16, 2014 OIG is stepping up audits of small health care providers who bill Medicare. For example, OIG just completed an audit of a physical therapy provider in Illinois who submitted 4,298 claims to Medicare for reimbursement in 2011 that totaled $645,966. Of the 4,298 claims, OIG audited just 100 of them and […]

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OIG is cracking down on fraud and abuse involving HIV drugs

Tuesday, September 16, 2014 OIG is cracking down on fraud and abuse involving HIV drugs which can cost Medicare up to $1,700/month for a single beneficiary. In an August 6, 2014 Podcast, OIG described two schemes involving HIV drugs. In one scheme, people exchanged HIV drug prescriptions for cash or other drugs. Then, a colluding […]

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