Under federal law, dispensing medications on the U.S. Department of Justice’s Controlled Substance Schedules without a valid prescription is considered a felony offense on par with selling illegal drugs. Depending on the specific medication involved, physicians, pharmacists, and other health care professionals found guilty of distributing controlled substances under 21 U.S.C. 841 can face years…
As a health care provider, one of the greatest risks to your business or practice is the risk of being targeted in a federal investigation. Several federal agencies are involved in the government’s ongoing fight against health care fraud, and the U.S. Department of Justice (DOJ), Centers for Medicare and Medicaid Services (CMS), and other…
Staggering Examples of Home Health Providers Hit with Multi-Million-Dollar Penalties and Prison Sentences Want to know which health care providers the DOJ and OIG will target for fraud investigations in the future? Follow the money. Home health services, including house calls and other mobile health services, are on the rise. They currently account for billions…
If you are being targeted in a Medicare fraud investigation, you are at risk for facing criminal charges. If you have heard this warning, while it is true, it only tells half of the story. While Medicare fraud investigations can lead to criminal charges, they can also lead to civil charges. Criminal and civil charges…
Why Medicare Is Scrutinizing Portable X-Ray Providers (And How We Can Help) When most people think about health care providers, they think of brilliant and accomplished white-collar professionals who help to meet some of society’s greatest needs. But when federal agents look at the health care industry, they see criminal suspects instead. More to the…
Why Companies Providing Mobile Blood Draws or Diagnostics Should Be on High Alert If you’re a health care professional or a medical executive, getting accused of Medicare fraud probably sounds like something that happens to other doctors or companies – the really bad ones. But the reality is that mobile lab companies are a top…
CMS, Ambulance Coverage, and Fraud Investigations: Bad for Patients, Dangerous for Providers When does someone really need an ambulance? That sounds like a question a doctor should answer. But doctors don’t ride along in EMS units. And in an emergency, there usually isn’t enough time to get a doctor on the scene (let alone obtain…
Enacted in 2004, 18 U.S.C. 1028A establishes the federal crime of “aggravated identity theft.” When pursuing charges for a felony offense such as bank fraud, mail fraud, or wire fraud, federal prosecutors will frequently pursue charges for aggravated identity theft as well. Aggravated identity theft carries a mandatory two year prison sentence. By statute, this…
Under the federal Anti-Kickback Statute, 42 U.S.C. 1320a-7b(b), health care providers are prohibited from engaging in a broad range of transactions that involve funds reimbursed from health care benefit programs (i.e., Medicare, Medicaid, and Tricare). Using program-reimbursed funds to pay for referrals, to provide rebates, and to provide other forms of “remuneration” is a felony…
The Latest Headlines & Figures from America’s Prescription Painkiller Problem (And the Consequences for Care Providers) 2018 is well underway, but we’re only just beginning to get a sense of what happened in 2016 in terms of national trends and death threats. Statistics take a while to catch up, especially when it comes to drug…
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