Several recently reported cases highlight the growing risk physicians face if they succumb to competitive pressures, especially offers of remuneration from labs, pharmacies, home health agencies and other providers to whom...more
The trend of holding physicians personally responsible for healthcare crimes has continued unabated over the past year. As noted in a previous article, physicians are particularly attractive targets for federal prosecutors...more
Aetna Life Insurance Company recently won a $37 million verdict against a group of Northern California surgical centers, Bay Area Surgical Management, LLC and its affiliates (collectively, Bay Area), for an alleged...more
4/22/2016
/ Aetna ,
Antitrust Violations ,
False Billing ,
False Claims Act (FCA) ,
Health Insurance ,
Healthcare Fraud ,
Insurance Industry ,
Kickbacks ,
Medical Reimbursement ,
Out of Network Provider ,
Physicians
In recent years, the U.S. Department of Justice (DOJ) has been criticized for failing to prosecute executives for fraud, particularly in the financial sector. In response, the DOJ has begun to more heavily emphasize...more
6/29/2015
/ Ambulance Providers ,
CEOs ,
Department of Justice (DOJ) ,
Durable Medical Equipment ,
Enforcement ,
Enforcement Actions ,
Fraud ,
Healthcare Fraud ,
Home Health Agencies ,
Hospitals ,
Medicare ,
Personal Liability ,
Pharmaceutical Industry ,
Pharmacies ,
White Collar Crimes
The Clinica de la Mama case could well serve as an instruction manual of what not to do to stay out of the government’s crosshairs. In this case, several hospitals entered into contracts for Clinica de la Mama to provide...more
The U.S. Department of Health and Human Services Office of Inspector General's (OIG) chief counsel indicated in 2007 that the government's fraud enforcement focus on large organizations was an "ineffective strategy" and that...more