According to the Associated Press (March 6, 2011), an Indiana pharmacist, John D. Love (owner of the Terre Haute Prescription Shop) “faces a possible 10-year prison sentence if convicted of health care fraud and money laundering in a scheme that netted him more than $3.57 million, federal prosecutors say.” The…
WPS, the Legacy Part B Medicare Administrative Contractor for Illinois, Michigan, Wisconsin and Minnesota, has issued recent guidance regarding documentation of discard or waste for drugs and biologicals as well as missing information on the Medicare CMS-855 provider enrollment applications. Notably, WPS voices CMS’ direction that physicians, hospitals, and other…
Gov. Snyder’s Executive Orders 2011-4 and 2011-5 reorganized DELEG, changing the name to the Department of Licensing and Regulatory Affairs (DLRA). Other notable changes include – Transferring the Bureau of Health Professions, the Bureau of Health Systems and the Controlled Substances Advisory Commission from the Department of Community Health to…
South Florida has been called the “national epicenter” for the illegal dispensing of prescription drugs. Law enforcement officials have targeted South Florida for quite some time, with February 23 being no exception. On February 23, law enforcement officials and Drug Enforcement Agency (DEA) agents raided six pain clinics accused of…
In a report issued last week, the Centers for Medicare and Medicaid Services (CMS) states that National Government Services, Inc. (NGS), the durable medical equipment (DME) Medicare administrative contractor for Jurisdiction B, inappropriately permitted $56.2 million in claims for CY 2007 for home blood-glucose test strips and/or lancet supplies used…
In its first civil monetary penalty issued for a covered entity’s violation of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, the Department of Health and Human Services (HHS), through its Office of Civil Rights (OCR), imposed a $4.3 million penalty on Cignet Health of Prince George’s County,…
Empire Blue Cross Blue Shield of New York, serving about 5 million members, is now instituting a pay-for-performance program that rewards physicians with greater reimbursement for complying with certain best practices. The aim is to encourage physicians to adopt best practices, so those who do not meet the standards will…
On Wednesday, February 16, the House Judiciary Committee approved a medical liability reform bill that would limit a plaintiff’s non-economic damages to $250,000. This vote comes at a time when tort reform has been in the spotlight as President Obama’s fiscal 2012 budget proposal included $250 million in grants over…
Over $225 million in false billing, 111 defendants, and 9 cities across the country. The Medicare Fraud Strike Force charged doctors, nurses, physical and occupational therapists, healthcare company owners and executives and others in the largest Medicare fraud takedown ever. The defendants are accused of various healthcare fraud-related crimes, including…
The 38-count indictment charged 20 individuals with various healthcare fraud, kickback and money laundering charges related to their alleged participation in a healthcare fraud scheme involving approximately $200 million in Medicare billing for mental health services. The defendants worked with and for American Therapeutic Corporation (ATC) and Medlink Professional Management…