Health Care Fraud Report Index-Summary

RACKETEER INFLUENCED AND CORRUPT ORGANIZATIONS (RICO) ACT

– Chiropractor, RICO charges dropped, billing claims remain (N.D. Ill.), 168; bad faith counterclaims disputed, 253
– Dentists' claims against insurers inadequately pled (11th Cir.), 429
– Medicaid fraud, Fla. woman arrested (Mich. Dist. Ct.), 259
– Neurontin, off-label marketing (D. Mass.), 87; Pfizer must pay $142M, 288
– Orthopedic devices, dismissal of antitrust and RICO claims affirmed (3d Cir.), 510
– State Farm auto insurance, civil RICO verdict upheld (E.D. Pa.), 519

RACs

See RECOVERY AUDIT CONTRACTORS (RACs)

RADIOLOGY SERVICES

– Kickbacks

– – Imaging machine approvals to be re-examined, IG, 786
– – Oncology center may offer free dietitian and social worker services, IG, 544
– – Preauthorization services for referrals, IG, 785

– Self-referrals, GAO study on Medicare spending sought, 378

REBATES

– Drugs, check recipients may be targets for fraud, 501
– Loophole, rebates uncollected by states, 242
– N.Y. probes health care credit card, 670
– Protonix, 17 states join case against Wyeth (D. Mass.), 414

RECOVERY AUDIT CONTRACTORS (RACs)

– Appealed RAC claims, more decided for providers, CMS report, 548
– Compliance issues for Medicare providers predicted to increase, 198
– Hospitals

– – Overpayment, magistrate report adopted (M.D. Fla.), 694
– – Reviews, administrative burden, survey, 767; auditor overlap, inconsistencies noted by Am. Hospital Assn., 768

– Medical necessity review audits approved, 690
– Outpatients

– – Observation services, overpayment audits discussed, 815
– – Research project, deferred auditing possible, 691

– Potential fraud referrals, IG, 161
– PPACA, random prepayment review issues, Insight, 473
– Program integrity effort shifts to prevention-based system, 767
– Provider documentation requests, specificity required, CMS article, 574
– Review, all states eligible by CMS, 374
– Strategies discussed at conference, Special Report, 715
– Weaknesses in RAC program, CMS slow to address, report says, 285; Senate panel hearing held, 608

RECRUITING

– Jobs

See EMPLOYMENT AND RECRUITING

– Patients

See PATIENT RECRUITING

REHABILITATION SERVICES

– Billing fraud, infusion and injection therapy, employee pleads guilty (E.D. Mich.), 345
– Medicare overpayments

– – Hospitals, IG, 546
– – Inpatient facilities, coding errors, IG, 570

REPORTING REQUIREMENTS

– Adverse events, compliance, 12
– Drugs

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

– Federal gift disclosure law discussed, 495
– Hospital's suspension of doctor reportable to federal data bank (11th Cir.), 800
– Medicaid, reform repayment rules, N.Y. official explains, 497
– NPDB

See NATIONAL PRACTITIONER DATA BANK (NPDB)

– SNF failed to report patient's changed condition, immediate jeopardy finding upheld (6th Cir.), 582
– Whistleblowers, professor's report of alleged violations raises fact issue (Tex. Ct. App.), 617

RESEARCH

– False claims to obtain funding (S.D.N.Y.), 29; qui tam suit to proceed, 454; psychiatrist and hospital, damages set, 664
– Fraud, anesthesiologist, doctor, guilty plea (D. Mass.), 78; formal plea entered, 217; sentence, 581
– Hospitals, case charging Alzheimer's data alteration dismissed (D. Mass.), 844
– Outpatient project, deferred RAC auditing possible, 691
– Pfizer discloses payments made to health care professionals, 349

RETALIATION

– Ambulance employee, Medicaid overpayments (W.D. Mich.), 79
– Hospice nurse need not report unlawful acts to licensing board (Md.), 428
– Hospital CEO, qui tam suit (W.D. Ky.), 30
– Lymphatic therapy clinic (11th Cir.), 166
– Nursing home supervisor, patient abuse reported (5th Cir.), 169

RETIREMENT HOMES

– Referrals, gift cards to residents not kickbacks, IG, 446

RICO

See RACKETEER INFLUENCED AND CORRUPT ORGANIZATIONS (RICO) ACT