Health Care Fraud Report Index-Summary

ABUSE

– Controlled substance

See SUBSTANCE ABUSE

– Elder

See ELDER ABUSE

ACQUIRED IMMUNE DEFICIENCY SYNDROME

See AIDS AND HIV

ADVERSE EVENTS

– Reporting requirements, compliance, 12
– Screening methods, problems, 203

AFFORDABLE CARE ACT

See PATIENT PROTECTION AND AFFORDABLE CARE ACT (PPACA)

AIDS AND HIV

– Infusion clinics

– – Former fugitive pleads guilty (S.D. Fla.), 700
– – Kickbacks, sentence (S.D. Fla.), 126
– – Money laundering, billing conspiracy, owner found guilty (S.D. Fla.), 616
– – Operator detained (S.D. Fla.), 425
– – Project New Hope, billing conviction affirmed (11th Cir.), 506

– Medical necessity, Miami, sentence (11th Cir.), 120
– NYC, $8.5M, doctors charged (S.D.N.Y.), 122
– Pharmaceuticals

– – Cash substituted for drugs, sentences (N.J. Super. Ct.), 463
– – Diluting, physician sentenced (C.D. Cal.), 215
– – Forged prescriptions, sentence (N.D. Ga.), 31
– – Infusion clinic executive and employee plead guilty (S.D. Fla.), 343
– – Kaletra, kickbacks for off-label use, partial dismissal (D. Mass.), 615
– – Technicians, guilty pleas (N.J. Super. Ct.), 85

– Research funds, falsely obtained (S.D.N.Y.), 29; qui tam suit to proceed, 454; psychiatrist and hospital, damages set, 664

ALABAMA

– CMS overpayments rule, state challenge partially dismissed (M.D. Ala.), 289
– Dental checkups at public schools, “free,” guilty plea, 393
– Medical devices, custom braces, firm owner arrested (Ala. Cir. Ct.), 762
– Pain injections, unlicensed personnel, Ala. doctor charged (N.D. Ga.), 702
– Pharmacy technician, false billing, guilty plea (N.D. Ala.), 616

ALASKA

– Privacy violations, mishandling Medicaid records alleged (Alaska Super. Ct.), 590

ALTERNATIVE MEDICINE

– Acupuncturist, auto insurance claims, sentence (S.D.N.Y.), 134

AMBULANCE SERVICES

– False claims, office manager found guilty (W.D. Va.), 578
– Kickbacks, ambulance/municipality deal, no sanctions, IG, 830
– Medical necessity, office manager sentenced (E.D.N.C.), 294
– NYC firms settle qui tam charges (E.D.N.Y.), 505
– Nonemergency dialysis treatment

– – Dallas, manager pleads guilty (N.D. Tex.), 294; owner pleads guilty, 843
– – Houston, owners sentenced (S.D. Tex.), 663
– – Unnecessary transports, executive sentenced (S.D. Tex.), 511

– Overpayments, whistleblower, retaliation (W.D. Mich.), 79

AMBULATORY CARE

– Accreditation, expansion to include home options considered, 765
– Anti-kickback laws, ambulatory care center allowed, IG, 732
– Pleading lacks particularity in qui tam suit against ambulatory surgery center (E.D. Va.), 662

ANESTHESIOLOGY SERVICES

– Carlisle, Pa. hospital, Stark and kickback claims go to trial (M.D. Pa.), 336
– Research fraud, guilty plea (D. Mass.), 78; formal plea entered, 217; sentence, 581

ANTI-KICKBACK LAWS

– Ambulance/municipality contract, no sanctions, IG, 830
– Brain tumor patients, assistance program allowed, IG, 731
– Charitable donations for use of software allowed, IG, 650
– Children, one free post-tonsillectomy stay allowed, IG, 787
– Clinics

– – Detroit-area, sentence (S.D. Fla.), 117
– – S. Fla., six people charged in $13M scheme (S.D. Fla.), 342; brothers plead guilty, 659; employee and nurse plead guilty, 701

– Doctor referrals

– – Agencies owner sentenced (E.D. Mich.), 30
– – Cardiologists referred to hospital, settlement (S.D. Ohio), 450
– – Ill. doctor-owned firm, IG settlement, 571

– Donations to tax-exempt group allowed, IG, 733
– Electronic health records, temporary certification, final rule, 545
– Grants and DME from nonprofit charity allowed, IG, 788
– “Honest-services” fraud law covers only bribery and kickbacks (U.S., aff, vac and rem), 550; implications of ruling, Insight, 594
– Hospitals

– – Anesthesiologists/hospital pact, claims go to trial (M.D. Pa.), 336
– – Attorney-client privilege (S.D. Ohio), 26
– – Cardiologists' declaratory judgment suit dismissed (S.D. Tex.), 618
– – Cincinnati health alliance and doctors' group settle claims, 548
– – Del. health care system settles claims (D. Del.), 210
– – Detox services, discovery protective order granted in part (E.D.N.Y.), 553
– – Discounts, Medigap insurer's proposal not fined, IG, 785
– – Emergency operations center approved, IG, 544
– – Heart device maker and hospitals settle claims (N.D. Ohio), 504
– – Homeless patient referrals, sentence (C.D. Cal.), 172
– – Medigap providers, no violations in discounted services, 202
– – Municipalities' waiver of Medicare cost-sharing allowed, IG, 544
– – Pay to play scheme, Cincinnati, settlement (S.D. Ohio), 115
– – Preauthorization for insurance by hospitals allowed, IG, 732
– – “Skid row” patients recruiting, hospital official sentenced (C.D. Cal.), 744
– – Sleep testing provider deal with hospital allowed, IG, 732
– – Software and hardware, survey sent, 65

– Infusion therapy

– – Billing, sentence (S.D. Fla.), 126
– – Doctor convicted (E.D. Mich.), 77; sentenced, 385

– Jurisdiction, conviction dismissed in part (11th Cir.), 699
– Medical devices

– – Cochlear implant supplier/provider payments may be disallowed, IG, 733
– – Government pleadings sufficient (N.D. Miss.), 288; motion to compel documents denied, 846
– – Orthopedic implant maker agrees to reforms (D.N.J.), 802
– – Pacemaker, part of second-filed suit proceeds (D. Colo.), 338
– – Qui tam suit, pleading inadequate (W.D. Mich.), 413

– N.C. bans payments for Medicaid patient referrals, 669
– Nursing home chains, soliciting Omnicare, charges settled (D. Mass.), 209
– Outlook, 42
– Pharmaceuticals

– – Aranesp, whistleblower suit dismissed (D. Mass.), 416; amended complaint to proceed, 803
– – Clinical testing lab and officers indicted (Mass. Super. Ct.), 591
– – Copay help for underinsured patients allowed, IG, 446
– – Human growth hormone, suit alleging drug maker caused fraud dismissed (D. Mass.), 756
– – Kadian, Alpharma settles claims (D. Md.), 247
– – Kaletra, off-label use, partial dismissal (D. Mass.), 615
– – Manufacturer to nursing home pharmacy firm (D. Mass.), 69
– – Nonprofit's drug cost assistance program approved, IG, 500
– – Procrit, original source disclosure (U.S., rev sought), 8; Solicitor Gen. view sought, 164; (rev den), 551

– Postmarket studies falsified

– – Medical devices, settlement, 15
– – St. Jude Medical, U.S. seeks to intervene (D. Mass.), 654; shareholders seek protection from costs (D. Minn.), 847

– PPACA

– – Accountable Care Organizations (ACOs), guidance sought, 835
– – Enforcement theories and compliance discussed, 648
– – Implications of key provisions, Insight, 676
– – Liability risk expanded, Insight, 312

– Psychiatric facility, CEO and doctor sentenced (N.D. Ill.), 30; ex-director sentenced, 172
– Radiology services

– – Oncology center may offer free dietitian and social worker services, IG, 544
– – Preauthorization services for referrals, IG, 785

– Retirement home referrals, gift cards to residents allowed, IG, 446
– Safe harbor proposal, IG, 10
– Transport firm owner charged (Mass. Dist. Ct.), 631
– Wheelchairs

See WHEELCHAIRS

ANTITRUST

– Accounting scheme allegation, WellCare settles case (M.D. Fla.), 658
– Drug price inflation, AstraZeneca settles claims, 552
– FCPA probe, SEC requests data from Merck, 691
– Orthopedic devices, dismissal of antitrust and RICO claims affirmed (3d Cir.), 510
– Postmarket studies and kickbacks, St. Jude Medical, shareholders seek protection from costs (D. Minn.), 847

APPEALS

– Filing deadline for qui tam suits, Eisenstein retroactivity (9th Cir.), 114; (U.S., rev den), 838

ARBITRATION

– Qui tam suit, motion to compel arbitration granted (N.D. Ohio), 748

ARIZONA

– Cardiac bioimpedance tests, Ariz. doctor settles charges, 836
– False claims, Scottsdale doctor sentenced (D. Ariz.), 663

ARKANSAS

– Hospice care, Medicare cap enforcement temporarily ceased (E.D. Ark.), 693
– SNF patients in immediate jeopardy, penalty (8th Cir.), 22
– State regulations, Medicaid Provider Manual/Fraud and Abuse, 559

ARMED SERVICES

– Drug distributors for military centers, overcharging claims settled, 572
– Mental health services firm, billing, owner sentenced (E.D.N.C.), 757

ATTORNEY-CLIENT PRIVILEGE

– Kickbacks (S.D. Ohio), 26
– Protective order to limit use of documents granted (E.D. Mich.), 556

ATTORNEYS

– Certification claims, Tenet Healthcare counsel charged (S.D. Fla.), 295; case time-barred, 382
– Fees, fraud claims, otorhinolaryngologist (9th Cir.), 74
– Ineffective assistance of counsel

– – Medicare conspiracy, motion to vacate sentences denied (S.D. Fla.), 613
– – SNF, convicted owner's claim rejected (C.D. Cal.), 453

– Privileged communication

See ATTORNEY-CLIENT PRIVILEGE

AUDITS

– False claims caused by auditor alleged, suit dismissed (S.D.N.Y.), 755
– Medicare Advantage (MA) plans

– – CMS pay-for-performance audit results discussed, 380
– – Risk adjustment data validation audits discussed, 815

– Office of Inspector General reports

See INSPECTOR GENERAL (IG), HHS

– Payment recapture audits, Obama urges agencies to expand use, 242
– RACs

See RECOVERY AUDIT CONTRACTORS (RACs)

– SNF owner convicted for obstructing audit not denied effective counsel (C.D. Cal.), 453

AUTOMOBILE INSURANCE

– Civil RICO verdict against State Farm upheld (E.D. Pa.), 519
– No-fault claims, doctor and acupuncturist, sentence (S.D.N.Y.), 134
– Privacy, data demand from medical providers limited (N.J. Super. Ct.), 856
– Protective order to limit use of documents granted (E.D. Mich.), 556
– Staged accident, seven arrested (Fla. Cir. Ct.), 813