Health Care Fraud Report Index-Summary

MALPRACTICE

– Medicaid contractors need not seek reimbursement from negligent providers (8th Cir.), 659
– Reporting

See NATIONAL PRACTITIONER DATA BANK (NPDB)

MANAGED CARE

See also HEALTH MAINTENANCE ORGANIZATIONS (HMOs)
– Accounting scheme allegation, WellCare settles case (M.D. Fla.), 658
– Contract suit against Aetna not barred by class action settlement (11th Cir.), 415
– Fla. unveils Medicaid fraud measure, 257; strike force to be established, 393
– MA

See MEDICARE ADVANTAGE (MA)

– Medicaid contracts, CMS review of state rate setting flawed, GAO reports, 650
– Quality Health Plans fined by CMS for noncompliance, 448

MARKETING

– Conflicts of interest

– – Drugs and devices, renewed scrutiny predicted, Insight, 269
– – Federal gift disclosure law discussed, 495
– – Pfizer discloses payments to health care professionals, 349

– DME telemarketing, Medicare beneficiaries, IG alert, 63
– FCPA probe, Eli Lilly provides update, 204
– Fla. regulators oppose solicitations from unauthorized insurers, 222
– Kickbacks

See ANTI-KICKBACK LAWS

– Kytril and Zofran, price inflation alleged, settlement, 760
– Medicare Advantage (MA), inappropriate marketing, 66
– N.Y., restrictions, drug and devices firms, 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
– Patient recruiting fraud

See PATIENT RECRUITING

– Vitamins marketing probed by Regence Blue Cross, 428

MARYLAND

– Drugs misbranded as generic, two firms dismissed from suit (D. Md.), 583; third firm dismissed, 747
– False claims act signed with limits on whistleblower suits, 346
– State regulations, employee's health benefits, 136
– Wrongful discharge, nurse need not report unlawful acts to licensing board (Md.), 428

MASSACHUSETTS

– Bone growth product, Stryker Biotech, disclosure of off-label use data denied (D. Mass.), 503; Stryker settles state claims (Mass. Super. Ct.), 764
– Dentist indicted on billing charges (Mass. Super. Ct.), 258
– Dermatology practice to repay Medicare for unnecessary tests, 573
– Medicaid

– – Specialty pharmacy Omnicare settles overcharging claims (N.D. Ill.), 795
– – 2009 recoveries by state, 133

– Nursing home not criminally liable for death of resident due to workers' negligence (Mass.), 442
– Pharmaceuticals

– – Actavis Elizabeth settles claims with state (D. Mass.), 257
– – Clinical testing lab and officers indicted for kickbacks (Mass. Super. Ct.), 591
– – Generic drug maker Watson settles case (D. Mass.), 170
– – Kaletra, kickbacks for off-label use, partial dismissal (D. Mass.), 615

– Postmarket studies and kickbacks, St. Jude Medical, U.S. seeks to intervene (D. Mass.), 654; shareholders seek protection from costs (D. Minn.), 847
– Rehabilitation therapy not provided, hospital settles claims, 161
– Research, case charging Alzheimer's data alteration dismissed (D. Mass.), 844
– State regulations, overpayments, 224
– Transcatheter aortic valve technology, Medtronic discloses probe over ties to clinic, 244
– Transport firm, kickbacks, owner charged (Mass. Dist. Ct.), 631
– Urine drug tests, billing fraud

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

MDL

See MULTIDISTRICT LITIGATION (MDL)

MEDICAID

See also specific states
– Claims database upgrades, House panel hearing, 200
– Excluded providers, enrollment analysis, IG report, 446
– False claims

See FALSE CLAIMS

– Fraud

– – Increased scrutiny predicted, Insight, 265
– – Prevention and enforcement

See LEGISLATION, FEDERAL, HR 5044, S 3632

– Hospitals

– – Place-of-service codes, incorrect payments reported, IG, 688
– – State-owned, disproportionate share payments, IG, 572
– – Supplemental payments, limits, 15

– Malpractice, contractors need not seek reimbursement from negligent providers (8th Cir.), 659
– Managed care, CMS review of state rate setting for managed care flawed, GAO reports, 650
– Nursing homes

– – Compliance violations, self-reported, lower penalties proposed, 570
– – Excessive payments, La. to repay CMS $122M, 286

– Overpayments, CMS rule, challenge partially dismissed (M.D. Ala.), 289
– Permanent error rate measurements

– – Eight error types specified, 332
– – Final error rate rule issued by CMS, 689
– – State-by-state, HHS details, 206

– Pharmaceuticals

– – Inflated payments, 67
– – Rebates

See REBATES

– – Savings by substituting generics, report, 610

– PPACA, screening of high-risk providers, enhanced methods proposed, 727; House panel hearing held, 790
– State fraud control units, IG debuts new web page, 381
– Unlicensed provider charged (D. Colo.), 621

MEDICAL DEVICES

– Adulterated or misbranded products, criminal charges, Insight, 635
– Atricure, unapproved uses, civil settlement, 111
– Billing

– – Custom braces, firm owner arrested (Ala. Cir. Ct.), 762
– – Mail fraud, Denver officers indicted (D. Colo.), 847

– Cardiology

See CARDIOLOGY

– Cochlear implant maker settles whistleblower claims (D. Colo.), 505
– Conflicts of interest

– – Federal gift disclosure law discussed, 495
– – Medtronic discloses payments to doctors, 519
– – Renewed scrutiny predicted, Insight, 269

– Durable equipment

See DURABLE MEDICAL EQUIPMENT (DME)

– Enforcement

– – Increased prosecution expected, 500
– – Trends, Special Report, 140

– FCPA

– – Bribery, devices industry target for prosecutions, lawyer says, 792
– – Global firms, cooperation with prosecutors, Special Report, 186

– Imaging machine approvals to be re-examined, IG, 786
– Importing unapproved devices, settlement, 15
– Kickbacks

– – Cochlear implant supplier/provider payments may be disallowed, IG, 733
– – Postmarket studies, settlement, 15

– Marketing

– – Italian firm Sorin Group settles claims, 245
– – N.Y., restrictions, gifts, 132
– – Off-label

See OFF-LABEL USE

– – Renewed scrutiny predicted, Insight, 269

– Medical devices, custom braces, firm owner arrested (Ala. Cir. Ct.), 762
– Orthopedic devices

– – Antitrust and RICO claims, dismissal affirmed (3d Cir.), 510
– – Kickbacks, implant maker agrees to reforms (D.N.J.), 802
– – Public disclosures of scheme, dismissal of qui tam suit affirmed (1st Cir.), 752

– Pleading inadequate, qui tam suit dismissed (W.D. Mich.), 413
– Surgical supplies, Medline Indus., relator claims adequate (N.D. Ill.), 213

MEDICAL RECORDS

– E-records

See ELECTRONIC HEALTH RECORDS

– HIPPA issues

See HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)

– Insurers, excessive fees for record retrieval, amended filing allowed (E.D. La.), 558
– Mishandling alleged (Alaska Super. Ct.), 590
– Pediatrician's seized patient files, suppression vacated (6th Cir.), 521

MEDICALLY NECESSARY SERVICES

– AIDS and HIV treatments, Miami, sentence (11th Cir.), 120
– Ambulance services

– – Dialysis patients, executive sentenced (S.D. Tex.), 511
– – Office manager sentenced (E.D.N.C.), 294

– Cataract surgery, unnecessary procedures alleged, partial dismissal (W.D. Wash.), 754
– Clinic, Detroit-area, Medicare scheme, sentence (S.D. Fla.), 117
– Dermatology practice, Mass., to repay Medicare, 573
– Home health care, Houston, indictments (S.D. Tex.), 584
– Hospitals

– – Admissions, unnecessary, five people charged (Fla. Cir. Ct.), 630
– – Homeless patients (C.D. Cal.), 76; guilty plea, 173; Intercare Health Sys. added to settlement, 458
– – Pleading, amended complaint ordered in qui tam suit (E.D. La.), 657
– – Unnecessary admissions, settlement (D. Minn.), 21
– – Waycross, Ga., qui tam suit, U.S. intervenes (S.D. Ga.), 337; doctor and hospital charged, 654

– Infusion therapy, doctor convicted (E.D. Mich.), 77; sentenced, 385
– Patient recruiting fraud

See PATIENT RECRUITING

– RAC program, medical necessity review audits approved, 690
– Wheelchairs

See WHEELCHAIRS

MEDICARE

– Atricure, unapproved uses, civil settlement, 111
– Biometrics and predictive modeling discussed at House panel hearing, 498
– Chemotherapy tests, denial of coverage ignored evidence (W.D. Pa.), 794
– Claims database upgrades, House panel hearing, 200
– Conspiracy, motion to vacate sentences denied (S.D. Fla.), 613
– Contractors, CMS oversight lacking, Grassley (R-Iowa) says, 831
– DME

– – Osteoarthritis device, Medicare payment denial upheld (D. Md.), 749
– – Part B claims, contractor's inappropriate payments, IG, 734
– – Rented equipment repairs, payment errors reported, IG, 653
– – Sentence for role in $3.2M scheme affirmed (11th Cir.), 383

– False claims

See FALSE CLAIMS

– Feeding tubes, enteral therapy claims, inappropriate claims cost, IG, 546
– Hospice care, questionable Medicare Part B claims identified, IG, 792
– Increased scrutiny predicted, Insight, 265
– Information security for contractors, gaps found, IG, 609
– Marketing

– – DME telemarketing, IG alert, 63
– – MA plans, inappropriate marketing, report, 66

– Nursing homes

– – Compliance violations, self-reported, lower penalties proposed, 570
– – Mental health, 2006 inappropriate Part B payments, IG, 569

– Overpayments not disclosed, CHRISTUS settles charges (C.D. Cal.), 838
– Pharmaceuticals

See MEDICARE DRUG COVERAGE

– Pleadings

– – False certification alleged, dismissal for pleading failure upheld (9th Cir.), 698; (U.S., rev sought), 848
– – Minimum requirements, Insight, 354

– PPACA, screening of high-risk providers, enhanced methods proposed, 727; House panel hearing held, 790
– Psychiatric facilities, inpatient, overpayments, IG, 501
– Racs

See RECOVERY AUDIT CONTRACTORS (RACs)

– Rehabilitation facilities, inpatient, coding errors, IG, 570
– Retroactive beneficiary liability, no sanctions for waiving, IG, 548
– Schemes, $65M, sentence (S.D. Fla.), 128
– Self-referrals for imaging and radiation therapy, GAO study sought, 378
– Senior Medicare Patrol programs

– – Administrator on Aging head Greenlee, Interview, 469
– – Grants awarded to 51 programs, 791
– – 2009 savings, IG, 445

– Sham infusion and injection services, clinic owner sentenced (E.D. Mich.), 293
– SNF, N.C., well-being and safety rules, penalties (4th Cir.), 117
– Standing, billing for test not performed, suit dismissed (S.D. Ohio), 758
– States, education and outreach urged, 494
– Strike force, expansion, 22; budget proposal, 107; House panel hears testimony on program, 199
– Support surface claims, payments, 10
– Trust fund, FY 2009, $2.5B recovered, 406; breakdown of fund transfers, 406
– Unlicensed provider charged with billing fraud (D. Colo.), 621
– Wheelchairs

See WHEELCHAIRS

MEDICARE ADVANTAGE (MA)

– Ed. Note: The name of this program was changed from Medicare+Choice to Medicare Advantage under the Medicare Prescription Drug, Improvement, and Modernization Act.
– Billing, Fla. resident with Tenn. firm indicted (M. D. Tenn.), 797
– Data review vendors should be hired, speakers say, 735
– False claims, $65M, sentence (S.D. Fla.), 128
– Marketing, inappropriate, report, 66
– PPACA, CMS pay-for-performance audit results discussed, 380
– Qui tam suit requires claims to government (D.N.J.), 452
– Risk adjustment data validation audits discussed, 815
– Sales agents

– – Inappropriate financial incentives, 203
– – Licensing and prompt payment violations, NYC HMO fined, 393

MEDICARE DRUG COVERAGE

– Ed. Note: Entries at this heading refer to Medicare Part D unless otherwise indicated.
– Adjusted rates, 2009 savings potential, IG, 570
– Data review vendors should be hired, speakers say, 735
– ESRD drugs, bundled payment rates, IG, 736
– Less-than-effective drug claims reported, IG, 690
– Oversight, safeguards lacking, Senate panel told, 201
– Part B-covered drugs

– – Fla.. falsified form resulted in overpayment (11th Cir.), 696
– – Late pricing submission reported, IG, 160

– Prescriber identifiers

– – Invalid identifiers in 2007, IG, 569
– – Timeline on plan to validate identifiers sought by Carper (D-Del), 651; CMS to begin probe, 737

– RACs

See RECOVERY AUDIT CONTRACTORS (RACs)

– Sponsors, formulary changes, notice, 16
– Zone Program Integrity Contractors

– – Billing probed, Insight, 188
– – CMS contractors, GAO sustains two protests, 202
– – Preventing fraud discussed at forum, 814
– – Unaccounted overpayment referrals, IG, 411

MEETINGS

See CONFERENCES AND MEETINGS

MENTAL HEALTH

– Behavioral care, May Inst. settles claims, 207
– Billing

– – Field trips, director sentenced (D. Idaho), 454
– – Lying to FBI about billing practices, psychiatrist pleads guilty (E.D. Mo.), 845
– – Owner of services firm sentenced (E.D.N.C.), 757
– – Pre-sentence report, calculation of losses remanded (6th Cir.), 614
– – Youth residential facility (W.D. Va.), 216; parent firm not liable for subsidiaries' acts, 656

– Bribery, shuttered facility, sentences (N.D. Ill.), 30; ex-director sentenced, 172
– Celexa for children and teens, settlement (D. Mass.), 741
– Counseling center owner indicted (N.J. Super. Ct.), 427
– Medicare

– – Overpayments, inpatient psychiatric facilities, IG, 501
– – Part B payments, inappropriate, during 2006 nursing home stays, IG, 569

– Patient care conditions, NYC hospital changes (E.D.N.Y.), 18
– Pharmaceuticals, off-label uses

– – Seroquel, claims settled, 372
– – Topamax, settlement, 373
– – Zyprexa

– – – Children, settlement (E.D.N.Y.), 336
– – – Deceptive claims, settlement (Miss. Cir. Ct.), 175

– Pleading, false claim complaint lacks particularity (S.D. Fla.), 846
– Psychiatrist, guilty plea (N.Y. Sup. Ct.), 35
– Research funds, falsely obtained (S.D.N.Y.), 29; qui tam suit to proceed, 454; psychiatrist and hospital, damages set, 664
– Submitting associate's work as own, doctor's conviction upheld (5th Cir.), 743
– Therapy services at SNFs, conviction upheld (7th Cir.), 213
– Unqualified provider, Houston, charges (S.D. Tex.), 217

MICHIGAN

– Ambulance employee/whistleblower, retaliation (W.D. Mich.), 79
– DME, Dearborn, ex-owner sentenced (E.D. Mich.), 746
– Health Inspector Gen., office created, 175
– Immigration and tax fraud, doctor sentenced (E.D. Mich.), 802
– Infusion therapy

– – Doctor and sham clinic employee convicted (E.D. Mich.), 290; sentenced, 342; clinic operator sentenced, 700
– – Rehabilitation center, employee pleads guilty (E.D. Mich.), 345
– – Sham services, clinic owner sentenced (E.D. Mich.), 293
– – Unnecessary, doctor convicted (E.D. Mich.), 77; sentenced, 385

– Kickbacks, doctor referrals, agencies owner sentenced (E.D. Mich.), 30
– Medicaid overcharging, Omnicare settles claims (N.D. Ill.), 795
– Medical necessity, tests, guilty pleas (S.D. Fla. and E.D. Mich.), 339; Mich. clinic, patient recruiter pleads guilty, 385; clinic owners seek new trial (E.D. Mich.), 745
– Nonphysicians, hospital settles (E.D. Mich.), 28
– Patient Choice Home Health Care, arrests (E.D. Mich.), 70; sixth guilty plea, 424; assistants plead guilty, 620; guilty plea, 805; sentence, 843
– Physical therapy

– – Farmington Hills, doctor convicted (E.D. Mich.), 250; therapist sentenced, 292; co-conspirator sentenced, 345; another therapist sentenced, 514; doctor sentenced, 693
– – Wayne County Therapeutic, clinic owner and employee sentenced (E.D. Mich.), 583

– Racketeering, Fla. woman arrested (Mich. Dist. Ct.), 259
– Unnecessary home visits, $9.5M settlement, 23
– Whistleblower suit, Genesys Health Sys. (E.D. Mich.), 24

MILITARY HEALTH CARE

– Drug distributors for military centers, overcharging claims settled, 572

MINNESOTA

– Hospital, unnecessary admissions, settlement (D. Minn.), 21

MISSISSIPPI

– Physical therapy, at-home care

– – Primary Med., unqualified employees, convictions (S.D. Miss.), 451; sentences, 750
– – Statewide Med., trial delayed (S.D. Miss.), 28

– State regulations, audits and monitoring reviews, 224; 305
– Zyprexa, deceptive claims, settlement (Miss. Cir. Ct.), 175

MISSOURI

– False claims for doctors not employed by clinic, sentences (E.D. Mo.), 295
– Health insurance

– – Bogus plan operators targeted, 179
– – Broker sentenced for Medicaid fraud (Mo. Cir. Ct.), 517
– – Discount plans, crackdown announced, 811

– Medicaid fraud

– – Efficiency of state unit, 85
– – Recovery rates, ranking among states, 591

– Mental health, lying to FBI about billing practices, psychiatrist pleads guilty (E.D. Mo.), 845
– Nursing homes

– – Long-term care, conspiracy, operators convicted (W.D. Mo.), 798
– – St. Louis, inadequate care (E.D. Mo.), 19

– Orthopedic clinic, St. Louis, settlement, 67
– Pain management clinic and billing firm settle charges (E.D. Mo.), 250
– Pediatrician settles state billing charges, 812
– Pharmacy technician charged with insurance fraud (E.D. Mo.), 430
– Podiatrist, obstruction of justice, guilty plea (E.D. Mo.), 81; sentence, 343
– Social worker, fine not excessive (Mo.), 589

MONEY LAUNDERING

– AIDS and HIV infusion clinic, owner found guilty (S.D. Fla.), 616
– DME, mechanic's sentence upheld (11th Cir.), 839
– Jurisdiction, conviction dismissed in part (11th Cir.), 699
– Physical therapy, conviction upheld (6th Cir.), 743

MONTANA

– State regulations

– – Health insurance high risk pool, 527
– – Medicaid provider manual, fraud and abuse, 632

MULTIDISTRICT LITIGATION (MDL)

– Drug prices, inflated, N.Y. Medicaid violations (D. Mass.), 124