Articles by Evan Sweeney
The shakeup continues for Philidor Rx Services LLC, which has dominated headlines over the last several weeks for its questionable relationship with pharmaceutical giant Valeant.
There's a new face at the Department of Justice this week, and it's one that the agency hopes will provide a "reality check" for corporate compliance programs throughout the country.
A California pharmacist that agreed to sell his small pharmacy for $350,000 to Philidor Rx Services is now suing the company, alleging Philidor committed "widespread fraud," according to the Los Angeles Times.
Medicare Part D pharmacy enrollment, drug reimbursement and durable medical equipment are among the new fraud and abuse focus areas targeted by the Office of Inspector General, according to agency's 2016 Work Plan.
Pharmaceutical executives have a long history of avoiding individual charges, even when the company they work for settles for billions to wipe away kickback claims. But the arrest of a pharmaceutical exec last week is one indication that the Yates memo released in September is more than just an empty threat from the feds.
A new federal directive will decrease the amount of hospital claims that Recovery Audit Contractors can review, effectively handcuffing the program's ability to root out improper payments.
Less than two months after outlining its intent to target executives entwined in corporate fraud schemes, the Department of Justice arrested a pharmaceutical executive and charged him with paying kickbacks to physicians.
The government resolved 110 cases involving civil monetary penalties and program exclusions in the past fiscal year, according to a senior official at the Office of Inspector General, and even more cases are expected in the coming year.
Specialty pharmacies have been praised for their ability to manage drugs that require special storage and administration, but over the last several days, the cottage industry has been exposed for its questionable relationship with drug companies.
The issue of unnecessary cardiac procedures has been building momentum for years, and fraud investigators are certainly well aware of the amount of federal dollars that circle the drain thanks to the trend. The problem, however, is that unnecessary procedures are difficult to identify based on claims data alone. Cardiologists may be the key to self-policing a specialty that is quickly spiraling out of control.