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All posts tagged with “Regulatory News | Fraud & Abuse News.”
FBI, DEA search Angel Bright Home Health offices Monday, along with state Medicare fraud unit
04/24/24 at 03:00 AMFBI, DEA search Angel Bright Home Health offices Monday, along with state Medicare fraud unit 3NEWS, Corpus Christi, TX, by Ana Tamez and Lexis Greene; 4/22/24 The FBI searched the Angel Bright Home Health Inc. offices Monday morning. FBI Public Affairs Officer Connor Hagan confirmed FBI-Houston agents were partnering with the Drug Enforcement Agency (DEA) and the Texas Medicaid Fraud Control Unit (MFCU) on an operation on Holly Road. ... 3NEWS found about a dozen agents at the home-health and hospice agency's office throughout the day Monday. At about 1:15 p.m., they began carting out boxes filled with documents and loading them into an unmarked box truck.
Support mounts for increased hospice accreditor oversight
04/24/24 at 02:00 AMSupport mounts for increased hospice accreditor oversightHospice News; by Holly Vossel; 4/16/24Calls are growing louder in support of increased accreditation organization oversight that could help curb fraudulent activity in the hospice space. In a proposed rule released in February the U.S. Centers for Medicare & Medicaid Services (CMS) introduced a number of provisions aimed at addressing conflicts of interest and establishing more consistent standards, processes and definitions among accreditation entities. The proposed increased oversight would be an important step forward in addressing instances of fraud, waste and abuse in hospice, according to members of the California Hospice and Palliative Care Association (CHAPCA). Regulatory changes such as these would be particularly significant in detecting maleficence in regions like California, which have a rise in program integrity challenges, the organization stated in a recent letter to Congress shared with Hospice News.Notable mentions: Sheila Clark, California Hospice and Palliative Care Association.
Health Care Fraud and Abuse 2023 Year in Review
04/17/24 at 03:00 AMHealth Care Fraud and Abuse 2023 Year in ReviewJD Supra; by Kevin Coffey, Meredith Eng, Haley Essner, Rebecca Hsu, Christopher Kim, Tessa Lancaster, Dayna LaPlante, Logan Moore, Angela Powers; 4/12/24 Polsinelli proudly introduces the Health Care Fraud and Abuse 2023 Year in Review, a comprehensive examination of the evolving landscape surrounding the False Claims Act (“FCA”) and fraud & abuse enforcement efforts in the United States. Since its significant amendments in 1986, the FCA has stood as a formidable tool in combating health care fraud, with the Department of Justice reclaiming over $75 billion in allegedly fraudulent proceeds.
Former nursing home CEO gets 2.5 years, must pay $11 million restitution for neglecting payroll taxes
04/15/24 at 03:00 AMFormer nursing home CEO gets 2.5 years, must pay $11 million restitution for neglecting payroll taxes McKnights Long-Term Care News, by Josh Henreckson; 4/9/24The former CEO of a healthcare administrative services company was sentenced Friday to 30 months in prison followed by two years of supervised release for failing to pay more than $10 million in payroll taxes at companies he owned. Josef Neuman had been CEO of a Lakewood, NJ, company that provided services to nursing homes and other healthcare providers, including around 20 that Neuman also co-owned.
Glendale, California men sentenced for role in $9M hospice fraud scheme – owner of San Gabriel Hospice and Palliative Care Inc. and Broadway Hospice Inc.
04/02/24 at 02:30 AMGlendale, California men sentenced for role in $9M hospice fraud scheme – owner of San Gabriel Hospice and Palliative Care Inc. and Broadway Hospice Inc.Sierra Sun Times; 3/31/24The owner of two California-based hospice companies, along with his biller and consultant, were sentenced last Thursday for their respective roles in a scheme that resulted in stealing over $9 million from Medicare in false and fraudulent claims for hospice services. ... According to court documents, ... [Gayk] Akhsharumov concealed his ownership and control over the hospice entities from Medicare, inserted nominee owners, paid kickbacks to patient recruiters, and profited from the scheme. In April 2020, after San Gabriel had ceased operations, Akhsharumov used the company to fraudulently obtain COVID-19 relief funds.
How sales and marketing compensation can get hospices into hot water
03/29/24 at 03:00 AMHow sales and marketing compensation can get hospices into hot waterHospice News, by Holly Vossel; 3/27/24Regulators are taking a closer look at how hospices pay their marketing and outreach workforces to curb fraudulent activity tied to referral streams. Federal and state regulatory agencies have systems in place to detect fraud, waste and abuse in hospice, and some are honing on oversight of sales, marketing and outreach staff payment arrangements, according to Ellen Persons, shareholder at Polsinelli Law Firm.
False Claims Act statistical year in review
03/28/24 at 03:00 AMEnforceMintz - False Claims Act statistical year in review Mondaq - Mintz; by Kevin M. McGinty, Laurence Freedman, Karen Lovitch and Brian Dunphy; 3/27/24 Mintz's annual report on False Claims Act case activity analyzes data from the DOJ and the firm's Health Care Qui Tam Database, and explores the 2023 spike in FCA case activity, the ongoing moderate decline in health care–related activity, and continuing robust recoveries in health care cases. ... Also interesting is the absence of hospice care facilities from this year's table. In a number of recent years, those entities had been a growing category of FCA defendants in our internal data.
Personal care workers received most Medicaid fraud convictions in 2023: OIG
03/20/24 at 03:00 AMPersonal care workers received most Medicaid fraud convictions in 2023: OIG McKnights Home Care, by Adam Healy; 3/15/24 More personal care workers were convicted for Medicaid fraud than any other provider type last year, according to a new report released Thursday by the Department of Health and Human Services Office of the Inspector General. OIG found that 279 personal care services (PCS) attendants were convicted of Medicaid fraud in 2023 — far more than the next four highest provider types combined. These convictions amounted to more than $10.5 million in criminal charges.
Care Alternatives, whistleblowers resolve hospice fraud suit
03/18/24 at 03:00 AMCare Alternatives, whistleblowers resolve hospice fraud suitBloomberg Law, by Daniel Seiden; 3/15/24
California Leads the State-Level Battle Against Hospice Fraud
03/15/24 at 02:30 AMCalifornia Leads the State-Level Battle Against Hospice Fraud Hospice News, by Jim Parker; 3/13/24As hospice program integrity remains in the spotlight, California remains the only state to take action on curbing the problem. Beginning in 2021, numerous reports emerged of unethical or illegal practices among hundreds of newly licensed hospices, particularly among new companies popping up in California, Texas, Nevada and Arizona. California’s Department of Justice (CDOJ) in 2021 issued a report detailing the state’s history of lax oversight.
Medicaid Fraud Control Units Fiscal Year 2023 Annual Report
03/15/24 at 02:00 AMMedicaid Fraud Control Units Fiscal Year 2023 Annual ReportU.S. Department of Health and Human Services, Office of Inspector General; 3/14/2024Medicaid Fraud Control Units (MFCUs or Units) investigate and prosecute Medicaid provider fraud and patient abuse or neglect. [This 32 page, downloadable document includes:]
Whistleblower cases on the rise nationwide; Sarbanes-Oxley, Dodd-Frank laws open door for more to speak out
03/13/24 at 03:00 AMWhistleblower cases on the rise nationwide; Sarbanes-Oxley, Dodd-Frank laws open door for more to speak out PressReader, Herald-Tribune; by Esteban Parra and Xerxes Wilson; 3/10/24A former medical director specializing in neurosurgery at southern Delaware's largest health care provider claims in a lawsuit that Bayhealth Medical Center misclassified "brain-dead" patients in order to overbill for services.
A whistleblower lawsuit cost ChristianaCare $47M. Why are whistleblower cases increasing?
03/06/24 at 03:00 AMA whistleblower lawsuit cost ChristianaCare $47M. Why are whistleblower cases increasing? Delaware Online, by Esteban Parra and Xerxes Wilson; 3/4/24A former medical director specializing in neurosurgery at southern Delaware’s largest health care provider claims in a lawsuit that Bayhealth Medical Center misclassified “brain-dead” patients in order to overbill for services. ... [The whistleblower reported that] hospital officials discussed a "new hospital initiative" in which suspected "brain-dead" patients would be discharged and admitted to hospice before any declaration of brain death, according to the lawsuit. The scheme allowed for prolonged billing where previous billing ended with the patient’s death, the complaint states. [Please refer to the article for details.]
What the UnitedHealth Group Antitrust Investigation means for Amedisys, home health industry
03/04/24 at 03:00 AMWhat the UnitedHealth Group Antitrust Investigation means for Amedisys, home health industry Home Health Care News, by Andrew Donlan; 3/1/24 Since the news surfaced Tuesday that the Department of Justice had opened an antitrust investigation into UnitedHealth Group (NYSE: UNH), additional questions have bubbled up. Namely, those questions surround the home health provider Amedisys Inc. (Nasdaq: AMED), which agreed to be acquired by UnitedHealth Group’s Optum in June of last year.
False Claims Act - 2023 Year in Review
03/01/24 at 03:00 AMFalse Claims Act - 2023 Year in ReviewJD Supra; by William Athanas, A. Lee Bentley III, Gene Besen, Ryan Dean, Jonathan Ferry, Daniel Fortune, Giovanni Giarratana, Ty Howard, Elisha Kobre, Anna Lashley, Gregory Marshall, Lyndsay Medlin, Stephen Moulton, Ocasha Musah, Scarlett Singleton Nokes, Cara Rice, Brad Robertson, Tara Sarosiek, Jack Selden, Erin Sullivan, Courtlyn Ward, Virginia Wright; 2/28/24As we do every year, this issue revisits the key cases and other developments from the year gone by. And by most metrics, 2023 was a notable year for the False Claims Act (FCA).
[Updated] CMS crackdown on fraudulent hospice providers in full effect in 2024, expert says
02/27/24 at 02:00 AM[Updated] CMS crackdown on fraudulent hospice providers in full effect in 2024, expert says McKnights Product Theater, by Adam Healy; 2/22/24In recent years, unscrupulous hospice providers have cropped up in California and other states. In response, the Centers for Medicare & Medicaid Services has prepared a slew of tools to curtail the fraud. States continue to feel the effects. As an example, a California hospice operator last week was convicted in a Medicare fraud scheme for billing nearly $3 million for services that patients did not need, according to the Department of Justice.
How one hospice owner got convicted of healthcare fraud and how you can avoid that fate
02/23/24 at 02:00 AMHow one hospice owner got convicted of healthcare fraud and how you can avoid that fateHospice Insights: The Law and Beyond, by Husch Blackwell; 2/21/24The owner of a Louisiana hospice was indicted and then convicted of healthcare fraud. How did that happen? In this [podcast] episode, Husch Blackwell's Meg Pekarske and Jonathan Porter talk about how a routine audit led to a whistleblower complaint by a hospice employee, which then led to the hospice owner’s criminal conviction following trial in November 2023. Most importantly, the pair discuss how other hospices can avoid that fate.
How CMS’ rule could tighten accrediting organization oversight
02/22/24 at 03:00 AMHow CMS’ rule could tighten accrediting organization oversightModern Healthcare, by Mari Devereaux; 2/20/24Accrediting organizations may have to reduce their fee-based consultation services and prohibit survey participation for employees with ties to health facilities or face penalties for violating conflict-of-interest provisions if the Centers for Medicare and Medicaid Services sticks with recent oversight proposals.Editor's Note: Full access to this article requires a subscription.
Doctor convicted of $2.8M hospice Medicare fraud scheme
02/21/24 at 03:30 AMDoctor convicted of $2.8M hospice Medicare fraud schemeHomeCare; 2/20/24A federal jury convicted a California man for his role in a scheme to defraud Medicare by billing $2.8 million for hospice services that patients did not need. From October 2014 to March 2016, [John] Thropay fraudulently certified Medicare patients ... as having terminal illnesses that the patients did not have ... [in order to] bill Medicare for hospice services. In 2015, Thropay was listed as an attending provider for more hospice claims paid by Medicare than any other provider in the nation.
Pharmacy in suit files for bankruptcy
02/15/24 at 03:00 AMPharmacy in suit files for bankruptcySan Antonio Express News, by Patrick Danner; 2/12/24County's litigation targets Trinity along with major retailers for the amount of opioids it dispensed. ... A lawyer for the county dubbed it a "pill mill." ... Trinity Pharmacies said in a court filing that 99% of prescriptions it fills are for patients in hospice care.
California Hospice Network: State falls short in curbing potential malfeasance
02/12/24 at 03:00 AMCalifornia Hospice Network: State falls short in curbing potential malfeasanceHospice News, by Jim Parker; 2/8/24The continued licensing of new hospices in California despite a moratorium is “deeply disturbing and frustrating,” the California Hospice Network (CHN) indicated in a statement. The practice is undermining efforts to combat hospice fraud, which has been rampant in California according to media and state government investigations. In 2021, the state enacted two hospice reform laws — Senate Bill 664 and Assembly Bill 1280 — designed to strengthen oversight, including a moratorium on new licenses and an extensive audit of California’s licensing and oversight processes.
Skowhegan nonprofits say they have moved on after former director stole thousands
02/01/24 at 04:00 AMSkowhegan nonprofits say they have moved on after former director stole thousands Portland Press Herald, by Jake Freudberg; 1/30/24Jason Gayne, the former executive director of the Skowhegan Regional Chamber of Commerce and the Hospice Volunteers of Somerset County, began his prison sentence Monday for stealing thousands from the nonprofits, but leaders of the two organizations said they have already worked to move forward. For the last two years, the Skowhegan Regional Chamber of Commerce has had a clear goal: returning the organization to its members. “From the ground up, we rebuilt everything,” said Luke York, the chair of the chamber’s board of directors.
Hospice fraud back in the spotlight, with new data also raising questions about home health care
02/01/24 at 03:00 AMHospice fraud back in the spotlight, with new data also raising questions about home health careHome Health Care News, by Robert Holly; 1/30/24The number of hospice providers enrolled in the Medicare program in four states has skyrocketed over the past few years. The jaw-dropping spike, in turn, has triggered increased oversight efforts – some of which may not be having the desired effect. A similar trend could be happening in home health care in one major county, U.S. Centers for Medicare & Medicaid Services (CMS) data suggests. In hospice, the surge of new providers and potentially fraudulent activities has been concentrated in Arizona, California, Nevada and Texas. In home health care, it’s Los Angeles County.
'Rock bottom': San Antonio doctor addicted to opioids wrote fake prescriptions for 40,000 doses
01/26/24 at 04:00 AM'Rock bottom': San Antonio doctor addicted to opioids wrote fake prescriptions for 40,000 dosesSan Antonio Express-News, by Guillermo Contreras; 1/23/24
Washington State reaches a nearly $150 million settlement with Johnson & Johnson over opioid crisis
01/26/24 at 04:00 AMWashington State reaches a nearly $150 million settlement with Johnson & Johnson over opioid crisisAP, by Manuel Valdes and Hallie Golden; 1/24/24The Washington state attorney general announced a $149.5 million settlement Wednesday with drugmaker Johnson & Johnson, more than four years after the state sued the company over its role in the opioid addiction crisis. “They knew what the harm was. They did it anyway,” Attorney General Bob Ferguson told reporters Wednesday.