Justice Department accuses Ontario-based hospital chain of cheating Medicare system

http://www.latimes.com/business/la-fi-prime-healthcare-20160525-snap-story.html

Centinela Hospital

The U.S. Justice Department has joined a whistle-blower case against Prime Healthcare Services, adding significant weight to allegations of widespreadMedicare overbilling at 14 of the company’s hospitals in California. A Los Angeles magistrate judge granted the agency’s request to intervene in the case Tuesday, one day after the government declared in a court filing that its investigation of the Ontario- hospital operator has “yielded sufficient evidence” that the facilities “submitted or caused the submission of claims to Medicare for unnecessary inpatient stays.”  Prime finds itself under federal scrutiny because of a whistle-blower complaint submitted in 2011 by Karin Berntsen, a registered nurse and director of quality and risk management at Alvarado Hospital in San Diego. Berntsen’s lawsuit accuses Prime of routinely making Medicare patients’ illnesses seem more severe than they really were in order to justify billing for additional services and increasing hospital admissions.

Wyeth and Pfizer Agree to Pay $784.6 Million to Resolve Lawsuit Alleging That Wyeth Underpaid Drug Rebates to Medicaid

https://www.justice.gov/opa/pr/wyeth-and-pfizer-agree-pay-7846-million-resolve-lawsuit-alleging-wyeth-underpaid-drug-rebates

DOJ Building

http://www.fiercehealthpayer.com/antifraud/story/pfizer-pays-785-million-resolve-drug-pricing-allegations/2016-05-02?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiTWpVd1lqSTNZalZsWWpReCIsInQiOiJINE9BNitVSm1VYUR3NFVOZG1YMFFiVFQ2d2lmRGtEZ01NdjVpY0x2bmZUSmxTVFFcL2NcL3FMTmlGaXJqRFhSUHI2Tm1yK0Q1MHU1R3U2OWlGQ3NVYU9uTll2VXMxcEJSdUxlcGlYSjJEV1ZBPSJ9

Maryland doctor sentenced for insurance fraud ordered to repay $3.1 million

http://www.healthcarefinancenews.com/news/maryland-doctor-sentenced-insurance-fraud-ordered-repay-31-million?mkt_tok=eyJpIjoiT0RZMFptTmtNMlJsTUdVMiIsInQiOiJuZjAwWEdTaDd6S0hXT0NjTlwvMXlTZ0oySVBWN3RFUFBcL1JGeDVWMFBSMEp4ekR6cFJXUjRhOEIrUkNVbEZuZFlBanQ0a3FPZ2Nzem1QbnQzZUxITDRKTlFVcjFTazRpc2ZVb0doR0lQTGRBPSJ9

Prison Cell

Paramjit Singh Ajrawat performed less expensive procedures but falsely billed for procedures that provided higher reimbursement amounts.

Houston psychiatrist sentenced 12 years for $158 million Medicaid fraud

http://www.healthcarefinancenews.com/news/houston-psychiatrist-sentenced-12-years-158-million-medicaid-fraud?mkt_tok=eyJpIjoiWWpNeFlqZ3hOekZrTW1NNSIsInQiOiJrbUR5S0JXcWFyQW1VcHhDZWxNbGJoOFI5cUdJZmdSdmNXOFV4cGRNSnpsTVBYQ0pMcEhrb2hTbkwyVUlHYUdLT2JPVTNXRFl1Q0p2NUdEMHZ5RTNpTmluU2VyYmRWOTFjZWZZVXp2ejQ5dz0ifQ%3D%3D

Fraud3

Sharon Iglehart was also ordered to pay more than $6 million in restitution, Department of Justice says.

Profiteering masquerades as medical care for injured California workers

Profiteering masquerades as medical care for injured California workers

Roger Brown’s doctor advised him to undergo back surgery in 2011 at Pacific Hospital of Long Beach, at the height of the cash-for-surgery scam. The operation did not go well, and he now relies on a caretaker to help him each day.

Roger Brown’s doctor advised him to undergo back surgery in 2011 at Pacific Hospital of Long Beach, at the height of the cash-for-surgery scam. The operation did not go well, and he now relies on a caretaker to help him each day.

How California’s health care system for workers forgot about fraud

Fierce Exclusive: Therapy benchmarks serve as a red flag for SNF false claims

http://www.fiercehealthpayer.com/antifraud/story/fierce-exclusive-therapy-benchmarks-serve-red-flag-snf-false-claims/2016-03-29?page=full

False Claims Act

A recent $125 million settlement, plus access to RUG utilization data, could lead to more investigations into corporate directives

Individual liability, physician compensation among top fraud concerns

http://www.fiercehealthpayer.com/antifraud/story/individual-liability-physician-compensation-among-top-fraud-concerns/2016-03-21?utm_medium=nl&utm_source=internal&mrkid=lead.Id&mkt_tok=3RkMMJWWfF9wsRokuKrKde%2FhmjTEU5z14ukkX6a2lMI%2F0ER3fOvrPUfGjI4HRcJjPK%2BTFAwTG5toziV8R7LMKM1ty9MQWxTk

Fraud

Click to access Healthcare_Fraud_2015.pdf

Fair market value and physician compensation: Key considerations and trends

http://www.beckershospitalreview.com/finance/fair-market-value-and-physician-compensation-key-considerations-and-trends.html

fair_market_value

Tenet near settlement on Georgia kickback charges, posts 2015 Q4 loss

http://www.healthcaredive.com/news/tenet-near-settlement-on-georgia-kickback-charges-posts-2015-q4-loss/414403/

51 hospitals reach $23M settlement as DOJ concludes cardiac device investigation

http://www.healthcaredive.com/news/51-hospitals-reach-23m-settlement-as-doj-concludes-cardiac-device-investig/414147/