Health Care

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Reining in Medicare Costs: New Facilities Fees Rule is now in Effect

Under Medicare rules in effect since 2000, hospital systems have been permitted to charge so called "facility fees" on top of their normal charges for professional care based on where the care took place. Reports issued in both 2012 and 2014 by the Medicare Payment Advisory Commission (MedPAC) found that Medicare often pays double for [...]

Feds Employ New Tactic in Battle against Health Care Fraud – Allege Violation of the “Travel Act” Executives, Surgeons, and Others Indicted in Texas in Massive Health Care Fraud Scheme

In December of 2016, 21 individuals, including the founders and investors of a physician-owned medical center in Dallas, Texas, were indicted by a grand jury and charged with an assortment of felony offenses stemming from their payment and/or receipt of over $40 million in bribes and alleged kickbacks. The now defunct operation, Forest Park Medical [...]

Hospice Companies Caught in Kickback Scheme, Pay $12 Million to Settle Allegations

Last month, we issued a client alert on the rising number of fraud, waste, and abuse cases being seen in the hospice care industry. Today we provide yet another example of the rising tide of hospice-related fraudulent schemes that the government is actively uncovering and prosecuting. This past Tuesday, the U.S. Attorney's Office, Northern District [...]

Former WellCare Executives Agree to Restitution and Civil Payments $ 26 million settlement wraps up Medicaid fraud case

In 2013, two former WellCare Health Plans Inc. executives (WellCare) were found guilty of health care fraud for their parts in devising and carrying out a fraudulent scheme that deceived the Florida Agency for Health Care Administration (AHCA), the Florida Healthy Kids Corporation (Healthy Kids), and WellCare's investors by retaining over $40 million in health [...]

Compounding Pharmacies Face Uphill Battle in FDA Investigations

A small compounding pharmacy in southeastern Pennsylvania has come to learn just how frustrating it can be to undergo an FDA investigation. Dorneyville Pharmacy (Dorneyville) in South Whitehall Township, Pennsylvania, underwent an FDA inspection from December 9, 2015 through January 7, 2016, after which the FDA inspector issued a “Form FDA 483” to the Dorneyville [...]

A New Frontier in Health Care Fraud: Hospice Care

In 2014, an estimated 1.6 to 1.7 million patients received services from a hospice provider. The Medicare hospice benefit is the predominate source of payment for that care. According to a study by the National Hospice and Palliative Care Organization, the percentage of hospice patients covered by the Medicare hospice benefit versus other payment sources [...]

CMS Hits 17 Medicare Plans with Civil Monetary Penalties

In recent weeks, 17 private insurers that provide drug coverage to seniors through Medicare Advantage and Medicare Part D plans were on the receiving end of notification letters informing them that the Centers for Medicare and Medicaid Services (CMS) was imposing civil monetary penalties for noncompliance with a range of Medicare prescription drug regulations. The [...]

HHS Office of Inspector General Releases FY2017 Work Plan Part II – Hospitals, Nursing Homes, and other Providers and Suppliers

In late 2016, the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) released its 2017 Work Plan. The plan lists the topics in which OIG sees the greatest potential for fraud under federal health care programs, primarily Medicare and Medicaid. The OIG updates its Work Plan throughout the [...]

Thought Leader Video Series: #1 How Might Attorney General Sessions and President Trump Change Fraud, Waste, and Abuse?

Anthony Calamunci and Brian Dickerson were interviewed by RXinsider on the status of the Pharmacy industry.  Each week FisherBroyles will provide access to the industry specific Q&A interview sessions hosted by RXinsider so you can learn what the newest legal and industry issues are and how to address these issues when running your pharmacy. Please [...]

Thought Leader Video Series: #11 How Do Pharmacies Utilize the Office of the Inspector General (OIG)?

Anthony Calamunci and Brian Dickerson were interviewed by RXinsider on the status of the Pharmacy industry.  Each week FisherBroyles will provide access to the industry specific Q&A interview sessions hosted by RXinsider so you can learn what the newest legal and industry issues are and how to address these issues when running your pharmacy. Please [...]