Archive

Question of the Week — Is it time for a legislative fix to limit sky high air ambulance costs?

Posted 06/14/19

Emergency Personnel Rushing to Helicopter Ambulance

As rural hospitals continue to shutter, accessible emergency medical care is out of reach for an increasing number of Americans. When health emergencies arise, patients in rural communities often must rely on helicopter ambulances to get them quickly to care. But the Government Accountability Office reported the median cost for a helicopter ambulance ride was over $36,000 in 2017. The problem will likely continue...

Tagged in: Ambulance, Question of the Week,

Catch of the Week — Wound Care Device Manufacturer ACell Inc.

Posted 06/14/19

Our Catch of the Week goes to ACell Inc., a Maryland-based medical device manufacturer that pleaded guilty to violating the Federal Food, Drug, and Cosmetic Act (FDCA) by failing to report that it had partially removed its wound-care product, MicroMatrix, from the market because it was contaminated with endotoxins, placing treated patients in danger of serious infection, even death, without informing the FDA that it...

Tagged in: Catch of the Week, FCA Federal, FDA Fraud, Medical Devices and DME, Whistleblower Case,

Question of the Week — Should the Medicare Fraud Hotline or HHS OIG Reward Informants?

Posted 06/7/19

Opioid manufacturer Insys Therapeutics agreed to a $225 million settlement related to allegations that it unlawfully marketed its drug Subsys and paid kickbacks to providers through “speaker programs” that rewarded providers who prescribed Subsys. We previously asked whether our readers thought CEOs should be more liable for corporate wrongdoing after the Insys CEO was convicted for participating in a criminal...

Tagged in: FCA Federal, Healthcare Fraud, Importance of Whistleblowers, Medicare, Question of the Week, Reporting to Government, Whistleblower Rewards,

Default by Nursing Home Chain on HUD-Guaranteed Mortgage Highlights Potential for Fraud in Section 232 Program

Posted 06/3/19

Last week, the New York Times reported on the collapse of Rosewood Care Centers, a chain of nursing homes with facilities in Illinois and Missouri. According to the report, the chain had faced years of operational and financial difficulties, including fines by state regulators, personal injury claims by residents, and lawsuits by investors and vendors. When it went under, Rosewood defaulted on $146 million in...

Tagged in: FCA Federal, Government Loan Programs, Housing and Mortgage Fraud, SNF,

DOJ Catch of the Week — Dr. Joseph Galichia

Posted 05/31/19

Paper Ripped Uncovering Medical Necessity Wording

This week's DOJ Catch of the Week goes to Kansas cardiologist Joseph Galichia. Yesterday, he agreed to pay $5.8 million to resolve allegations that he and his company, Galichia Medical Group, violated the False Claims Act by billing federal health care programs for medically unnecessary cardiac stent procedures. This is the government's third False Claims Act settlement with Dr. Galichia. Which may explain why he also...

Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

United States Intervenes in Home Health Care Fraud Case

Posted 05/30/19

Doctor Hand Taking Money from Patient's Hand

Last week, the United States intervened in a lawsuit brought against Florida-based Doctor’s Choice Home Care and its two owners. The Department of Justice alleged that the company bribed doctors to refer patients in violation of the federal Anti-Kickback Statute and Stark Law. Both laws prohibit medical providers from paying or receiving kickbacks in connection with government-funded health care...

Tagged in: Anti-Kickback and Stark, FCA Federal, Government Decision, Home Health and Hospice, Whistleblower Case, Whistleblower Eligibility,

Intermountain Settles Dispute Pending Before Supreme Court, Leaving 9(b) Ambiguity Unresolved

Posted 05/24/19

Earlier this month, a Utah-based hospital chain announced it would settle whistleblower Dr. Gerald Polukoff’s case alleging the hospital performed unnecessary heart surgeries on Medicare patients, thereby overcharging the federal government in violation of the False Claims Act (FCA). Defendant Intermountain Health, the largest healthcare provider in the Intermountain West, had petitioned the U.S. Supreme Court to...

Tagged in: Court Decision, FCA Federal, FCA Pleading, Healthcare Fraud, Hospital Fraud, Lack of Medical Necessity,

Question of the Week — Should institutions return past donations from Big Pharma executives and their family members implicated in the opioid crisis?

Posted 05/23/19

The New York Times recently reported that the Metropolitan Museum of Art has decided to stop accepting gifts from members of the Sackler family linked to Purdue Pharma, the maker of OxyContin, one of the drugs at the center of the opioid epidemic that has killed more than 200,000 Americans in the past two decades. The Met’s decision follows that of other museums and universities, including the Tate Modern, the...

Tagged in: Healthcare Fraud, Pharma Fraud, Question of the Week,

Question of the Week — Should the CEO Be Held Accountable?: Lessons from the Insys verdict.

Posted 05/10/19

Handcuffed business-leader walking through jail.

In a shocking first, a federal jury has convicted an opioid-company CEO and other top executives of a criminal racketeering conspiracy. Insys founder and chairman John Kapoor and four other executives bribed doctors to overprescribe a highly addictive fentanyl painkiller, and ran a phony call-center to defraud insurance companies into paying for the expensive drug. Although the company itself had already paid over...

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Defendants, Dosage Fraud, Healthcare Fraud, Lack of Medical Necessity, Off-Label and Unapproved Use, Pharma Fraud, Question of the Week,

Catch of the Week — Pharmaceutical Company Allegedly Bribed Doctors with Trips to the Kentucky Derby

Posted 05/8/19

Cartoon of Sick Monkey and Horse Doctor Doing Check-Up

A recent settlement between the Department of Justice and US WorldMeds (“USWM”), show how creative, and how luxurious, kickbacks allegedly paid to physicians can be. The company, a pharmaceutical manufacturer, agreed to pay $17.5M to resolve claims that it violated the False Claims Act by paying kickbacks to patients and doctors by boosting sales of two of their drugs, Apokyn (a drug used to treat Parkinson’s...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Importance of Whistleblowers, Whistleblower Case, Whistleblower Rewards,

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Question of the Week — Is it time for a legislative fix to limit sky high air ambulance costs?

Catch of the Week — Wound Care Device Manufacturer ACell Inc.

Question of the Week — Should the Medicare Fraud Hotline or HHS OIG Reward Informants?

Default by Nursing Home Chain on HUD-Guaranteed Mortgage Highlights Potential for Fraud in Section 232 Program

DOJ Catch of the Week — Dr. Joseph Galichia

United States Intervenes in Home Health Care Fraud Case

Intermountain Settles Dispute Pending Before Supreme Court, Leaving 9(b) Ambiguity Unresolved

Question of the Week — Should institutions return past donations from Big Pharma executives and their family members implicated in the opioid crisis?

Question of the Week — Should the CEO Be Held Accountable?: Lessons from the Insys verdict.

Catch of the Week — Pharmaceutical Company Allegedly Bribed Doctors with Trips to the Kentucky Derby

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