December 19, 2016

10 Times “Health Care” was a hot mess in 2016

By chirosushi In HIPAA, Malpractice, News

So much money on the table. So much time to do illegal, unethical and immoral acts in the name of “health.”

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Pharmaceutical Executives Charged in Racketeering Scheme

BOSTON – Several pharmaceutical executives and managers, formerly employed by Insys Therapeutics, Inc., were arrested today on charges that they led a nationwide conspiracy to bribe medical practitioners to unnecessarily prescribe a fentanyl-based pain medication and defraud healthcare insurers.

The indictment alleges that Michael L. Babich, 40, of Scottsdale, Ariz., the former CEO and President of the company; Alec Burlakoff, 42, of Charlotte, N.C., former Vice President of Sales; Richard M. Simon, 46, of Seal Beach, Calif., former National Director of Sales; former Regional Sales Directors, Sunrise Lee, 36, of Bryant City, Mich. and Joseph A. Rowan, 43, of Panama City, Fla.; and former Vice President of Managed Markets, Michael J. Gurry, 53, of Scottsdale, Ariz., conspired to bribe practitioners in various states, many of whom operated pain clinics, in order to get them to prescribe a fentanyl-based pain medication.  The medication, called “Subsys,” is a powerful narcotic intended to treat cancer patients suffering intense episodes of breakthrough pain.  In exchange for bribes and kickbacks, the practitioners wrote large numbers of prescriptions for the patients, most of whom were not diagnosed with cancer. Read more

Case tied to cancer doctor fraud settled for $200K

A health care company will pay $200,000 to resolve allegations it paid Farid Fata, the former cancer doctor convicted of Medicare fraud, in exchange for patient referrals, federal officials said.

Vitas Health Corporation Midwest and related entities have agreed to pay the settlement, U.S. Attorney Barbara McQuade said in a statement Tuesday.

The agency accused the Miami-based company of paying Fata for referrals to its hospice care services.

Last year, federal officials accused Fata of giving chemotherapy to cancer-free patients while also overmedicating others. His operation was part of a wide-reaching health insurance scheme to scam Medicare and Blue Cross/Blue Shield out of about $34 million in insurance payments. – Read full article

Physician sentenced to 18 months in prison for selling oxycodone prescriptions

On Nov. 18, former podiatrist Frederick Weintraub was sentenced to 18 months in prison for illegally selling prescriptions of Oxycodone in Rock Island County, N.Y. Dr. Weintraub pled guilty to one count of distributing an illegal controlled substance on Aug. 5.

According to The Record, Dr. Weintraub’s New Jersey state medical license was revoked in December 2015 after he continued to practice medicine in the state even though his license was suspended in 2012 over multiple allegations of sexual misconduct. Dr. Weintraub was charged with one count of criminal sexual contact in 2012 after he allegedly groped and fondled the breast of a patient. Those charges were ultimately dismissed.

Jury convicts home healthcare owner in $13M Medicare fraud conspiracy

A Houston-based home health agency owner was convicted of various counts of conspiracy to commit healthcare fraudand conspiracy to pay and receive healthcare kickbacks for her role in a $13 million Medicare fraud scheme, according to the Department of Justice.

Walgreens files breach-of-contract lawsuit against Theranos

Deerfield, Ill.-based Walgreens filed a civil lawsuit in federal court in Delaware against Palo Alto, Calif.-based blood testing startup Theranos, alleging breach of contract and seeking $140 million in damages, The Wall Street Journal reports. – Read more

NY cardiologist pleads guilty in attempt to kill competitor

Dr. Moschetto’s plot to kill was uncovered during an investigation earlier this year into a tip given to the Drug Enforcement Agency that unusually high numbers of oxycodone prescriptions were coming from his office.

The cardiologist was arrested in April after he offered an undercover police officer $5,000 to have a rival physician assaulted and $20,000 to have him killed, according to the NBC report. A video recording shows Dr. Moschetto giving the undercover officer $500 and unwritten prescriptions as a retainer for the hit job. Police also linked Dr. Moschetto to a prior arson attempt on the rival physician’s office, according to the report. – Read more

Former Calif. senator who accepted bribes from ex-hospital CEO gets prison time

LOS ANGELES – Former California State Senator Ronald S. Calderon was sentenced today to 3½ years in federal prison after pleading guilty to a federal corruption charge and admitting that he accepted tens of thousands of dollars in bribes in exchange for performing official acts as a legislator. – read full story

New York Doctor Convicted of Multimillion-Dollar Health Care Fraud

A New York surgeon who practiced at hospitals in Brooklyn and Long Island, New York, was convicted last night for submitting millions of dollars in false and fraudulent claims to Medicare.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Robert L. Capers of the Eastern District of New York, Assistant Director in Charge Diego G. Rodriguez of the FBI’s New York Division and Special Agent in Charge Scott Lampert of the U.S. Department of Health and Human Services-Office of Inspector General (HHS-OIG) New York Regional Office made the announcement.

Syed Imran Ahmed, 51, of Long Island, New York, was convicted of one count of health care fraud, three counts of making false statements related to health care matters and two counts of money laundering. – Read more

Physician who falsely diagnosed 387 patients gets 4-year prison term

Isaac Kojo Anakwah Thompson, MD, of Delray Beach, Fla., has been sentenced to 46 months in prison after pleading guilty in March to one count of healthcare fraud for engaging in a scheme to defraud the Medicare Advantage program, according to the Department of Justice.

Medicare pays the sponsoring insurance company a capitated monthly fee for each beneficiary who chooses to enroll in a Medicare Advantage plan. The fixed fee is adjusted based on the beneficiary’s medical conditions. As a result, Medicare typically pays a larger capitated fee for a beneficiary with more serious medical conditions than it does for a healthier beneficiary. – read more

Highmark sues feds over $223M in ACA payments

Highmark, the insurance arm of Pittsburgh-based Highmark Health, is suing the federal government, claiming the U.S. failed to pay the insurer nearly $223 million in payments owed under the Affordable Care Act’s risk corridor program.

The risk corridor program is designed to temporarily level the financial playing field for payers by limiting both unexpectedly high gains and losses associated with participating in a new insurance market. Insurers that saw greater profits paid into a pool to compensate insurers with higher losses. The three-year program, which runs through 2016, fell short by more than $2.5 billion in its first year because so many insurers experienced losses in the individual market.– read more

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