Tuesday, March 31, 2020

Win-Win Situation

One of the most typical ways providers commit medical billing fraud is by charging for services not provided. Thanks to a retired health care consultant and former administrator who blew the whistle on a Los Angeles-based cancer institute, allegations that the company defrauded public...

If the Shoe Fits

Military service can put a lot of pressure on feet. Overuse can not only cause injuries and inflammation to bones, ligaments and joints, it can also lead to bunions, plantar fasciitis and arthritis. (Oh, my aching feet!) Today’s “Fraud of the Day” is particularly...

You Get What You Pay For

As most Americans know, having access to affordable pharmaceuticals is a challenge. But circumventing laws to bring unapproved drugs over the border – and then charging the government – is never the answer. A Philadelphia-area doctor has learned this lesson the hard way and...

Compounding Problems

Pharmaceutical sales can be a rewarding and lucrative career field. But when the desire for profits trumps following the law, sales reps can go to jail. A 45-year-old Camden, N.J., man is facing 20 years in prison after pleading guilty to one count each of...

Bogus Bonuses

Workplace performance bonuses are a great thing, unless they are driven by incentives that can send you to jail. That is the case for a pair of Texas women who were convicted recently on six counts of healthcare fraud that involved overbilling the federal...

Spoiled Specimens

One way that people working in healthcare defraud public insurance systems is by paying kickbacks for referrals and asking for reimbursements for services never rendered. It’s that kind of behavior that has an Illinois medical lab owner behind bars. The 62-year-old man, from Madison County,...

Follow the Rules!

It’s not uncommon for healthcare providers to get caught not following healthcare laws regulating prescription medications and billing to Medicaid and Medicare. And when they do, the penalties are often steep. An Ashland, K.Y., physician learned this the hard way after settling civil claims...

Home-Health Fraud

People who qualify for Medicaid’s home healthcare coverage are some of the most vulnerable among us. They are impoverished or disabled and count on home-health workers to help them with basic needs. But that doesn’t stop some people from stealing from the program and...

Hypocrite

Depending on the labor and ingredients required, costs for compounded medications can be quite expensive. A Georgia podiatrist committed healthcare fraud by participating in a kickback scheme that generated patients who supposedly needed compounded medications. He collaborated with a pharmacy, who billed the unnecessary...

Beware of Rising Premiums

A Washington, D.C.-based insurance broker was in a good position to get rich off one of the U.S.’s biggest health insurance companies. That is, until the law caught up with him. Now, he’s facing prison time for healthcare fraud and identity theft. A federal jury...

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