Officals at the Department of Justice say they are focusing on unusual kickback schemes, including instances in which companies loan equipment free of charge or pay healthcare providers to use a certain product, according to Arent Fox's blog Health Care Counsel.
A vast web of bribes, kickbacks, counterfeit hardware and a legislative loophole allowed one California spine surgeon to cash in on spinal fusion surgeries for which the state paid millions of dollars, according to an article by Los Angeles Magazine.
Florida's addiction treatment industry is overrun with marketers who collect as much as $500 for each addict they refer to a treatment center or halfway house, and often coerce recovering addicts with cash for drugs to get them into detox programs, according to a BuzzFeed News investigation.
In 2012, Olympus warned European hospitals that one of its medical scopes was harboring dangerous bacteria. More than two years later, U.S. hospitals reported infectious outbreaks linked to the same scope that ultimate infected more than 250 people between 2012 and 2015. The patient safety debacle left many wondering how this could happen. A massive kickback scheme that predated the outbreak offers some belated clues, revealing an eroded corporate culture that valued profits over compliance, regardless of the repercussions.
Physician compensation, individual liability outlined in the Yates memo and the Supreme Court's ruling on implied certification are now among the chief healthcare fraud concerns, according to a report from Bass Berry Sims PLC.
Prescribing practices are at the center of fraud prevention and opioid addiction treatment as New York prepares for a new e-prescribing law and as new opioid addiction legislation passed easily through the Senate.
A pharmacy benefits manager has dropped a Fort Worth, Texas, compounding pharmacy facing a federal fraud investigation, and another under the same ownership after an audit raised "significant concerns of fraud," according to the Dallas Morning News.
Although the long-term impact of the Department of Justice's Yates memo has yet to be seen, the first six months under the new policy contains some clues as to how the new approach will impact fraud investigations, according to a report by the law firm Paul Hastings.
In April 2015, Tricare spent $545 million on compounded pharmaceuticals, more than 58 times its monthly spending just three years prior. The spike in spending marked the peak of a gradual increase in spending on compound drugs that accelerated during the first several months of 2015 as Tricare was initiating changes to its pharmaceutical formulary. Now, federal investigators are digging into pharmacies that may have relied on marketers to generate referrals, while shielding the true effectiveness and cost of compounded medications.
The federal government collected $2.4 billion through the Healthcare Fraud and Abuse Control (HCFAC) program during fiscal year (FY) 2015, nearly one-third less than the previous year.