Health Care Fraud Report Index-Summary

PACKAGING

See LABELS AND PACKAGING
– Off-label marketing

PAIN MANAGEMENT

– Billing firm and clinic settle charges (E.D. Mo.), 250
– Chiropractor with expired license, pain center owner fined (N.J. Super. Ct,), 465
– Conspiracy, Houston doctors plead guilty (S.D. Tex.), 384
– Injections by unlicensed personnel, Ala. doctor charged (N.D. Ga.), 702
– Untrained personnel, manager sentenced (E.D. Tex.), 27

PART B DRUG BENEFIT

See MEDICARE DRUG COVERAGE

PART D DRUG BENEFIT

See MEDICARE DRUG COVERAGE

PATIENT DUMPING

– Baby's death after treating pregnant accident victim, no liability (E.D. Okla.), 126; rehearing denied, 384
– Disparate screening claims go to jury (D. Nev.), 578
– Inpatient EMTALA liability, Solicitor Gen. brief sought, 70; (U.S., rev den), 579
– Nursing home transfer, charge dropped (3rd Cir), 383

PATIENT PROTECTION AND AFFORDABLE CARE ACT (PPACA)

– Accountable Care Organizations (ACOs)

– – Changes needed to qualify for ACO status, 833
– – Guidance sought on avoiding fraud issues, 835

– Contractors, random prepayment review issues, Insight, 473
– Disclosure

– – Amendment to FCA bar, Special Report, 309
– – Burdens predicted to increase, Special Report, 307
– – N.Y. and federal self-disclosure duties overlap, official says, 761
– – 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
– – Transparency provisions and fraud deterrence, Special Report, 530

– Drugs, rebate recipients may be targets for fraud, 501
– Elder abuse advisory board, nominations sought, 611
– “Excluded persons”

– – IG authority

See LEGISLATION, FEDERAL, HR 6130

– – Preparations for listings urged, 499

– Implications of key provisions, Insight, 676
– Insurance plans

– – Loss-ratios should include fraud expenses, groups say, 464; tax treatment, draft released, 791
– – Scams since enactment, Sebelius addresses, 331

– Kickbacks

– – Enforcement theories and compliance discussed, 648
– – Liability risk expanded by Act, Insight, 312

– MA plans, pay-for-performance audit results discussed, 380
– Natl. Provider Identifier (NPI) required for claims, CMS rule, 375
– Nursing homes, CMS seeks on several provisions, 380
– Overpayment return and other issues vague, lawyers say, 407
– Reconciliation bill, transparency and disclosure initiatives, Insight, 320
– Screening of high-risk providers, enhanced methods proposed, 727; House panel hearing held, 790
– Self-referrals, Stark Law exceptions tightened for hospitals, 543
– States

– – Compliance review sought by Senator, 375
– – Medicare education and outreach urged, 494

– Terminated providers, CMS notice, 547

PATIENT RECRUITING

– Home health care, clinic owner, nurses and recruiter plead guilty (S.D. Fla.), 661
– Infusion clinic operators and recruiters sentenced (S.D. Fla.), 660
– Physical therapy and diagnostic services, NYC clinic charged (E.D.N.Y.), 422
– “Skid row” patients, hospital official sentenced (C.D. Cal.), 744
– Tests, unnecessary, guilty pleas (S.D. Fla. and E.D. Mich.), 339; Mich. clinics, conspiracy plea, 385; clinic owners seek new trial (E.D. Mich.), 745
– Wheelchairs

See WHEELCHAIRS

PATIENT RIGHTS

– Nursing homes, suing for violations (U.S., rev sought), 32; (briefs filed), 118; (rev den), 167

PBM

See PHARMACY BENEFITS MANAGEMENT (PBM)

PENALTIES

See also SANCTIONS
– Cal., 13 hospitals, medication errors, 131
– CMPs

See CIVIL MONETARY PENALTIES (CMPs)

– Drugs, reporting noncompliance, enforcement planned, IG, 789
– False claims fine imposed on social worker not excessive (Mo.), 589
– Methadone clinics, N.J. seeks $51.5M, 84
– N.J., increases signed, 588
– Wheelchairs, Los Angeles, $1M fraud (C.D. Cal.), 122

PENNSYLVANIA

– Anesthesiologists/Carlisle hospital pact, Stark and kickback claims go to trial (M.D. Pa.), 336
– Chiropractors

– – Blue Cross claims, indictment (E.D. Pa.), 135
– – Horsham health club, chiropractor charged (E.D. Pa.), 512
– – Rehab One health club and chiropractor charged (E.D. Pa.), 260

– Hospitals

– – HIPAA, employee allegedly disclosed patient data, indictment (W.D. Pa.), 756
– – Philadelphia, overbilling claims resolved, 657

– Physician, Pittsburgh, $3.3M plea agreement (W.D. Pa.), 80
– Social service employees sentenced for billing fraud (E.D. Pa.), 515

PHARMACEUTICALS

See DRUGS AND PHARMACEUTICALS

PHARMACISTS AND PHARMACIES

– Billing fraud

– – Fla., Medicare scheme, sentence (S.D. Fla.), 695
– – Technician pleads guilty (N.D. Ala.), 616

– Cash substituted for AIDS drugs, sentences (N.J. Super. Ct.), 463
– Connecticut

– – Greenwich, pharmacist sentenced (Conn. Super. Ct.), 424
– – Manchester, pharmacist pleads guilty (Conn. Super. Ct.), 302

– Controlled substances

– – Anxiety and insomnia, online sales, doctor sentenced (D.N.J.), 349
– – Discounted drugs, online sales, owner sentenced (N.D. Tex.), 33
– – Technician charged with insurance fraud (E.D. Mo.), 430

– DME claims, NYC pharmacy owner settles (S.D.N.Y.), 801
– New Jersey

– – False claims restitution ordered (D.N.J.), 670
– – Federal workers' health plan defrauded, guilty plea (D.N.J.), 514
– – Forged prescriptions, protection for pharmacists, 86

– Overcharging, Omnicare settles Mich. and Mass. claims (N.D. Ill.), 795
– PBM

See PHARMACY BENEFITS MANAGEMENT (PBM)

– Transparency proposal, benefit managers' comments sought, 243
– Workers' comp plan, CVS settles drug inflation claims (Mass. Super. Ct.), 760

PHARMACY BENEFITS MANAGEMENT (PBM)

– Transparency proposal, feedback sought, 243

PHYSICAL THERAPY

– Billing

– – Comparative billing reports, CMS program begun, 690
– – False claims, $1.8M settlement, 590

– Conspiracy

– – 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

– False claims, conviction upheld (6th Cir.), 743
– Home services

– – Failure to file qui tam complaint under seal, dismissal upheld (6th Cir.), 840
– – Primary Med., unqualified employees, convictions (S.D. Miss.), 451; sentences, 750
– – Statewide Med. trial delayed (S.D. Miss.), 28

– Lakeland, Fla., clinic owner arrested (M.D. Fla.), 80
– Patient recruiting, NYC, kickbacks alleged (E.D.N.Y.), 422
– Service of process, timeliness (D.N.J.), 125

PHYSICIANS

– AIDS and HIV

– – Assistants, unnecessary treatments, Miami, sentence (11th Cir.), 120
– – Billing mill, $8.5M, NYC, doctors charged (S.D.N.Y.), 122
– – Diluting medications, physician sentenced (C.D. Cal.), 215

– Cancer drugs not provided, doctor pleads guilty (C.D. Cal.), 341
– Cardiologists

– – Billing fraud, doctor sentenced (N.D. Ill.), 701; civil charges settled, 807
– – Bioimpedance tests, Ariz. doctor settles charges, 836

– Conflicts of interest

– – Medtronic discloses payments to doctors, 519
– – Specialists' group adopts ethics code, 395

– Controlled substances

See SUBSTANCE ABUSE

– Dentists

See DENTAL CARE

– Dermatologists

– – Billing fraud, resentencing ordered (9th Cir.), 698
– – Ex parte patient interviews allowed during discovery (N.D. Ill.), 575
– – NYC, falsely obtained certification, settlement (S.D.N.Y.), 507
– – Revoked billing privilege upheld (D. Mass.), 421
– – Unnecessary tests, Mass. practice to repay Medicare, 573
– – Whistleblower/HIPAA concerns, amended case (E.D. Tenn.), 456

– Evidence

– – Medical board files denied defendant physician (Tex. Ct. App.), 516
– – Pediatrician's seized patient files, suppression vacated (6th Cir.), 521

– Eye care

See EYE CARE

– False claims

See FALSE CLAIMS; QUI TAM SUITS

– Hospice care, questionable Medicare Part B claims identified, IG, 792
– Hospital's suspension of doctor reportable to federal data bank (11th Cir.), 800
– Immigration and tax fraud, doctor sentenced (E.D. Mich.), 802
– Infusion clinic, Fla. doctor sentenced (S.D. Fla.), 166
– Kickbacks

See ANTI-KICKBACK LAWS

– Medicare fraud, NYC doctor arrested (E.D.N.Y.), 799
– Neurosurgeon, hospital contract, loan payments (S.D. Cal.), 124
– NPDB

See NATIONAL PRACTITIONER DATA BANK (NPDB)

– Orthopedic surgeon, billing fraud, guilty plea (D.N.J.), 222
– Pain

See PAIN MANAGEMENT

– Pediatricians

See generally CHILDREN'S HEALTH CARE

– Plastic surgeons, misbranding drugs as Botox (N.D.N.Y.), 180
– Psychiatrists

See MENTAL HEALTH

– Self-referrals

See SELF-REFERRALS

– Standing, billing for test not performed, suit dismissed (S.D. Ohio), 758
– Test results falsified, doctors indicted (E.D. Cal.), 457

PLEADING

– Ambulatory surgery center, false claims pleading lacks particularity (E.D. Va.), 662
– Bad faith, hospital may seek sanctions (W.D.N.Y.), 216; sanctions imposed, 511
– Dentists' RICO claims against insurers inadequately pled (11th Cir.), 429
– Drug switch suit, consumer fraud charges inadequate (N.D. Ill.), 222
– FQHC officer, qui tam suit, details (M.D. Ga.), 75
– Insurers, excessive fees for record retrieval, amended filing allowed (E.D. La.), 558
– Medical devices

– – Kickbacks, government pleadings sufficient (N.D. Miss.), 288; motion to compel documents denied, 846
– – Qui tam suit, pleading inadequate (W.D. Mich.), 413

– Medicare

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

– Mental health centers, false claim complaint lacks particularity (S.D. Fla.), 846
– Off-label use, Cardioblate system, particularity lacking (S.D. Tex.), 841
– OxyContin, marketing fraud, insufficient pleading (4th Cir.), 303; employment pact issue (U.S., rev sought), 740; (rev den), 837

PPACA

See PATIENT PROTECTION AND AFFORDABLE CARE ACT (PPACA)

PREEMPTION

– Conflicts of interest, federal gift disclosure law discussed, 495
– FCA bars qui tam suits based on state disclosures (U.S., rev and rem), 282

PREGNANCY AND CHILDBIRTH

– EMTALA, no liability for baby's death after treating pregnant accident victim (E.D. Okla.), 126; rehearing denied, 384

PRESCRIPTION DRUGS

See generally DRUGS AND PHARMACEUTICALS
– Controlled substances

See SUBSTANCE ABUSE

PRICING

See DRUGS AND PHARMACEUTICALS

PRIVACY AND CONFIDENTIALITY

– Attorney-client privilege

See ATTORNEY-CLIENT PRIVILEGE

– Auto insurance, data demand from medical providers limited (N.J. Super. Ct.), 856
– Chiropractor's conviction for intercepting patient conversations upheld (6th Cir.), 214
– HIPPA cases

See HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)

– Mishandling Medicaid records alleged (Alaska Super. Ct.), 590

PRIVILEGED COMMUNICATIONS

– Attorney-client

See ATTORNEY-CLIENT PRIVILEGE