Health Care Fraud Report Index-Summary

DATABASES AND DATA BANKS

– Claims, database upgrades, House panel hearing, 200
– Detecting fraud, role of data mining techniques explored, 831
– Error-rate data to identify providers not used by CMS, IG, 832
– Fla. seeks CMS waiver for “data mining” of billing records, 589; waiver granted, 629
– MA and Part B plans should hire data review vendors, speakers say, 735
– NPDB

See NATIONAL PRACTITIONER DATA BANK (NPDB)

– Predictive modeling and analytics to fight fraud, Special Report, 674
– Privacy, HIPAA, portable disk drive (D. Conn.), 73
– Sharing data would help to fight fraud, report, 834
– Stark exceptions for e-records, comments sought on data collection burdens, 735
– Taxes, CMS/IRS data sharing

See LEGISLATION, FEDERAL, HR 4213

DELAWARE

– Kickback claims settled by Del. health care system (D. Del.), 210

DENTAL CARE

– Billing fraud

– – Unlicensed personnel, oral surgeon indicted (S.D. Tex.), 580
– – Unperformed services, conviction (S.D. Tex.), 806

– Drug trafficking, dentist sentenced (Ky. Cir. Ct.), 37
– False claims, dentist indicted (N.D. Tex.), 702
– FCA case to proceed against dentist convicted of Medicaid fraud (W.D. Va.), 554
– “Free” checkups at public schools, guilty plea, 393
– Medicaid fraud, indictment (Mass. Super. Ct.), 258
– RICO claims against insurers inadequately pled (11th Cir.), 429
– Substandard care, low-income children, $24M settlement (D. Md.), 72

DEPARTMENTAL APPEALS BOARD

– Digests of recent decisions of Appellate Division, 623; 849
– Digests of recent decisions of Civil Remedies Division, 81; 128; 254; 295; 385; 389; 458; 585; 622; 664; 702; 705; 807; 850; 852

DIABETES

– Artificial limbs, diabetic supplies (S.D. Tex.), 171
– Ind. warns patients of scam, 557
– Risperdal

– – Minimizing risk, jury verdict against drug maker (La. Parish Ct.), 855
– – Utah sues drug makers (Utah Dist. Ct.), 426

– Seroquel, state sues drug makers (Utah Dist. Ct.), 426
– Zyprexa, deceptive claims, settlement (Miss. Cir. Ct.), 175

DIALYSIS

See END-STAGE RENAL DISEASE (ESRD)

DIETARY SUPPLEMENTS

See VITAMINS AND DIETARY SUPPLEMENTS

DISCIPLINARY ACTIONS

See PENALTIES; SANCTIONS

DISCLOSURE

– Adverse events, reporting requirements, compliance, 12
– Aggregate spend laws and sunshine, compliance challenges, BNA Insights, 533
– Bone growth product, Stryker Biotech, disclosure of off-label use data denied (D. Mass.), 503
– Conflicts of interest

– – Federal gift disclosure law discussed, 495
– – Medtronic discloses payments to doctors, 519
– – Pfizer discloses payments made to health care professionals, 349
– – Researcher/industry ties, support for disclosure studied, 395

– HIPAA, hospital employee allegedly disclosed patient data, indictment (W.D. Pa.), 756
– Home health care, DOJ requests Amedisys documents, 789
– Insurer alleging fraud must disclose related document (D. Mass.), 464
– Medicare overpayments not disclosed, CHRISTUS settles charges (C.D. Cal.), 838
– Orthopedic implants, public disclosures of scheme, dismissal of qui tam suit affirmed (1st Cir.), 752
– PPACA

– – Amendment to FCA public disclosure bar, Special Report, 309
– – Burdens predicted to increase, Special Report, 307
– – N.Y. and federal self-disclosure duties overlap, official says, 761
– – Reconciliation bill, transparency and disclosure initiatives, Insight, 320
– – Stark Law violations, CMS releases self-disclosure protocol, 784; reduced repayment discussed at forum, 814; fundamental changes, Insight, 862
– – State officials intend to defer to federal provisions, 710

– Procrit, kickbacks, original source disclosure (U.S., rev sought), 8; Solicitor Gen. view sought, 164; (rev den), 551
– Qui tam suits based on state disclosures barred by FCA (U.S., rev and rem), 282
– Self-referrals

– – Cardiologists seek quick start to disclosure protocols, 378
– – Hospitals, two-track review process urged, 609

– Transcatheter aortic valve technology, Medtronic discloses probe over ties to clinic, 244

DISCOVERY

– Attorney-client privilege, kickbacks (S.D. Ohio), 26
– Hospitals

– – Billing fraud, discovery of DOJ memos (D. Idaho), 169
– – Kickbacks, detox services, discovery protective order granted in part (E.D.N.Y.), 553

– Qui tam suits

– – Ex parte patient interviews allowed (N.D. Ill.), 575
– – Sanction for discovery delays (M.D. Pa.), 76

– SNF, “under arrangements” provider, discovery ordered (D. Utah), 661

DME

See DURABLE MEDICAL EQUIPMENT (DME)

DOCTORS

See PHYSICIANS

DOJ

See JUSTICE DEPARTMENT (DOJ)

DRUGS AND PHARMACEUTICALS

– Abuse

See SUBSTANCE ABUSE

– AIDS drugs

See AIDS AND HIV

– Antibiotic TOBI, Novartis to pay $72M settlement, 410
– Cancer drugs not provided, doctor pleads guilty (C.D. Cal.), 341
– Cardiac drugs, unapproved, settlement, 373
– Charity discounts, illegal resales, sentence upheld (11th Cir.), 695
– Conflicts of interest

– – Federal gift disclosure law discussed, 495
– – Pfizer discloses payments made to health care professionals, 349
– – Renewed scrutiny predicted, Insight, 269
– – Researcher/industry ties, support for disclosure studied, 395

– Controlled substances

See SUBSTANCE ABUSE

– Corporation as original source, Ven-A-Care pharmacy (D. Mass.), 114; Teva settles for $315M, 159; Teva settles federal and state claims, 629
– Enforcement trends, Special Report, 140
– Forged prescriptions

– – Cancer drugs, sentence (N.D. Ga.), 31
– – N.J., pharmacist protection, 86

– Global firms

See FOREIGN CORRUPT PRACTICES ACT (FCPA)

– Hospitals, Cal., medication errors, penalties, 131
– Inflated prices

– – Actavis Elizabeth settles claims with state (D. Mass.), 257
– – AstraZeneca settles claims, 552
– – Boehringer Ingelheim and related firms, $7.75M settlement (Wis. Cir. Ct.), 392
– – Generic drug maker Watson settles (D. Mass.), 170
– – Medicaid payments, 67
– – N.Y. Medicaid violations (D. Mass.), 124
– – Sandoz settles Medicaid case (Idaho Dist. Ct.), 855
– – Utah, average wholesale price suit dismissed (Utah Dist. Ct.), 220

– Jurisdiction, Raplon, whistleblower case, original source (3d Cir.), 165
– Kickbacks

– – 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
– – Nonprofit's cost assistance program approved, IG, 500
– – Nursing home pharmacy (D. Mass.), 69
– – Omnicare solicitations, nursing home chains settle charges (D. Mass.), 209
– – Procrit, original source disclosure (U.S., rev sought), 8; Solicitor Gen. view sought, 164; (rev den), 551

– Levothroid and Celexa, false claims, settlement (D. Mass.), 741
– Marketing

– – Kytril and Zofran, price inflation alleged, settlement, 760
– – N.Y. restrictions, gifts, 132
– – Off-label

See OFF-LABEL USE

– – OxyContin, insufficient pleading (4th Cir.), 303; employment pact issue (U.S., rev sought), 740; (rev den), 837
– – Renewed scrutiny predicted, Insight, 269

– Medicaid rebates

See REBATES

– Military centers, wholesale drug distributors, overcharging claims settled, 572
– Misbranding

– – Botox

– – – Allergan settles claims (N.D. Ga.), 738
– – – Fraud by plastic surgeons (N.D.N.Y.), 180

– – Criminal charges, Insight, 635
– – Lyme disease treatment, conspiracy, guilty plea (D. Kan.), 797
– – OxyContin, drug firm executives, exclusions (D.D.C.), 119

– Nitroglycerin SR, ineligible for Medicaid (D. Mass.), 165
– Part D/Part B drug benefit

See MEDICARE DRUG COVERAGE

– Pharmacists and pharmacies

See PHARMACISTS AND PHARMACIES

– Pleading inadequate in drug switch suit (N.D. Ill.), 222
– Qui tam relators may use documents obtained by state enforcers (S.D. Tex.), 612
– Reporting requirements

– – Free samples, Vt. to enact law, 462
– – Generic drug prices, false reporting verdict against Merck (D. Mass.), 796
– – Noncompliance, penalty enforcement planned, IG, 789
– – Unapproved drugs, KV Pharm. pleads guilty (E.D. Mo.), 209

– Research fraud, anesthesiologist, guilty plea (D. Mass.), 78; formal plea entered, 217; sentence, 581
– Risperdal, diabetes link

– – Minimizing risk, jury verdict against drug maker (La. Parish Ct.), 855
– – Utah sues drug makers (Utah Dist. Ct.), 426

– Savings by substituting generics, report, 610
– Seroquel, diabetes link, state sues drug makers (Utah Dist. Ct.), 426
– SNF, “under arrangements” provider, discovery ordered (D. Utah), 661
– Urine drug tests, Mass. labs

– – Clinical Science, settlement, 762
– – Life Labs., settlement, 177

– Whistleblowers

– – Aranesp, suit dismissed (D. Mass.), 416; amended complaint to proceed, 803
– – FCA programs, Grassley (R-Iowa) seeks info from firms, 568
– – Motivation described in article, 409

DURABLE MEDICAL EQUIPMENT (DME)

– Adult diapers

– – Firm owner indicted (S.D. Tex.), 171; pleads guilty, 344; sentenced, 757
– – Houston, federal grand jury indictments (S.D. Tex.), 577

– “Arthritis kits”

– – Doctor and supply firm owner plead guilty (S.D. Tex.), 552
– – Family Med. Services, guilty pleas (S.D. Tex.), 292; health care fraud guilty plea, 806; Medicare fraud guilty plea, 842

– Artificial limbs, diabetic supplies (S.D. Tex.), 171
– Billing

– – Dearborn, ex-owner sentenced (E.D. Mich.), 746
– – Hialeah, conviction (S.D. Fla.), 121

– Collateral attack, convicted supplier's suit rejected (E.D. Cal.), 620
– Competitive bidding program, CMS delays announcing winners, 830
– Consignment closets, CMS limitation rule rescinded, 160
– Conspiracy

– – Mechanic's fraud sentence upheld (11th Cir.), 839
– – One-year prison sentence (C.D. Cal.), 19

– Enrollment requirements, stricter safeguards adopted, 730
– Fla., supplier sentence upheld (11th Cir.), 696
– Houston firm, resentencing ordered on willful obstruction (5th Cir.), 419
– Kickbacks

– – Government's pleadings sufficient (N.D. Miss.), 288; motion to compel documents denied, 846
– – Grants and DME from nonprofit charity allowed, IG, 788

– Lacary Med. Services, owner sentenced (S.D. Fla.), 425
– Longview, Tex., operator pleads guilty (S.D. Tex.), 619
– Los Angeles, guilty plea (C.D. Cal.), 127
– Medical supply firm charged (E.D. Pa.), 20
– Medicare

– – Part B claims, contractor's inappropriate payments, IG, 734
– – $3.2M fraud, sentence affirmed (11th Cir.), 383

– Orthopedic kits, indictment (E.D. Tex.), 173
– Orthotic equipment, supply owner sentenced (N.D. Tex.), 340
– Osteoarthritis device, Medicare payment denial upheld (D. Md.), 749
– Pharmacies, NYC, owner settles false claims charges (S.D.N.Y.), 801
– Qui tam suit against Lifetime Med. Supplies dismissed (E.D. Ark.), 747
– Rented equipment repairs, payment errors reported, IG, 653
– San Antonio, Tex., $1.8M scheme, owners indicted (W.D. Tex.), 77
– Sentence, 87-month, for DME operator upheld (11th Cir.), 513
– Sham firm, $1.5M scheme, operator convicted (D. Mass.), 344; sentenced, 700
– Southern Cal. firm owner pleads guilty (C.D. Cal.), 342
– Supply firm owner, $36M scheme, 30-year sentence (S.D. Tex.), 74
– Support surface claims, Medicare payments, 10
– Telemarketing, Medicare beneficiaries, IG alert, 63
– Threatening Medicare officials during probe, sentence (S.D. Fla.), 215
– Wheelchairs

See WHEELCHAIRS