In a press release issued by the US Department of Justice of the Eastern District of Pennsylvania, a 498-count indictment–240 counts of which involved healthcare fraud–charged 53 defendants, including a physician and pharmacist, in a multi-million dollar drug conspiracy. The press release states that William Stukes–a drug trafficker of Philadelphia–and…
On July 21, 2011, the Office of Inspector General (OIG) of the Department of Health & Human Services (HHS) announced that Administrative Law Judge (ALJ) Steven T. Kessel upheld OIG’s exclusion of Michael D. Dinkel from participation in all Federal health care programs under section 1128(b)(7) of the Social Security…
The Centers for Medicare & Medicaid Services (“CMS”) recently released the Medicare Fee-For-Service Recovery Audit Program (“RAC”) statistics for the third quarter of the fiscal year (“FY”) 2011. $233.4 million of overpayments was collected during that time period. In comparison, only $55.9 million of underpayments was returned during the same…
On July 8, New York Governor Andrew Cuomo nominated James Cox, a former high-level federal auditor, as New York’s new Medicaid Inspector General. The nomination is seen as an important step in increasing New York’s crackdown on Medicaid fraud. Medicaid Fraud has been a major problem for the state of…
Medicare beneficiaries are able to obtain power wheelchairs when medically necessary under Medicare Part B. From 1999 to 2003, Medicare saw a 350 percent increase in payments for power wheelchairs. The $900 million jump raised concerns regarding the appropriateness of these Medicare payments. Although the new policies implemented in subsequent…
The Department of Justice announced on June 30, 2011 that a Las Vegas physician, Rakesh Nathu, settled False Claims Act allegations with the United States for $5.7 million plus interest. Nathu allegedly submitted false claims to Medicare, TRICARE and the Federal Employees Health Benefits Plan for various radiation oncology services…
On June 30, 2011, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule which eliminates the requirement that physicians and non-physician practitioners must sign requisition forms for clinical diagnostic laboratory tests. The original policy was established by the final 2011 Medicare Physician Fee Schedule, but it was…
Federal law enforcement officials announced on June 29, 2011 that Jacinto “John” Gabriel, Jr., a Chicago man responsible for operating two home health care businesses, was indicted in an alleged $20 million Medicare fraud scheme spanning five years. The 15-count indictment includes health care fraud, wire fraud, and money laundering.…
On June 23, 2011, the Departments of Justice and Health and Human Services announced that, under the aegis of the inter-agency Health Care Fraud Prevention and Enforcement Action Team (HEAT) program, three employees of the Solstice Wellness Center, a Brooklyn-area clinic that purported to specialize in providing physical therapy and…
By correcting vulnerabilities identified by Recovery Audit Contractors (“RACs”) and similar Medicare contractors, the Centers for Medicare and Medicaid Services (“CMS”) hopes to reduce the rate of mistakes uncovered by the Comprehensive Error Rate Testing (“CERT”) program. Diagnosis Related Group (“DRG”) Validation review is one of the processes RACs utilize…