Fraud Concerns Emerge As Compounding Drug Sales Skyrocket

http://khn.org/news/fraud-concerns-emerge-as-compounding-drug-sales-skyrocket/?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=31763903&_hsenc=p2ANqtz–PhnRVqf1RHh-WdXHoa-6YIFwbpAP91jYtikc1hViYnou3e1JAym3sE42hOTDnYQVJsB-bnamM0o8kX8UBXNumXh190w&_hsmi=31763903

Mortar pharmacy

Government spending on “compounded” drugs that are handmade by retail pharmacists has skyrocketed, drawing the attention of federal investigators who are raising fraud and overbilling concerns.

Spending on these medications in Medicare’s Part D program, for example, rose 56 percent last year, with some of the costliest products, including topical pain creams, priced at hundreds or thousands of dollars per tube. The federal workers’ compensation program has also seen a recent spike in spending.

The spending jump, along with a sharp increase in the number of patients getting the compounded drugs “may indicate an emerging fraud trend,” said Miriam Anderson, who helped oversee a June report on the Medicare spending by the inspector general’s office at the Department of Health and Human Services.

Some of the prescriptions may not have been medically necessary — or even dispensed at all, notes the report, which also details recent fraud cases brought by U.S. attorneys in several states.

Feds, states turning to predictive analytics to prevent fraud

http://www.fiercehealthpayer.com/antifraud/story/feds-states-turning-predictive-analytics-prevent-fraud/2015-10-19?utm_medium=nl&utm_source=internal

Cystall Ball

OIG: Data helps federal authorities keep pace with evolving fraud schemes

Healthcare organizations: Steer clear of vendors with ties to terrorism

http://www.hospitalimpact.org/index.php/2015/08/06/healthcare_executives_hire_terrorists_at?utm_medium=nl&utm_source=internal&mkt_tok=3RkMMJWWfF9wsRovuarMZKXonjHpfsXx7uUrWKeg38431UFwdcjKPmjr1YoJSMJ0aPyQAgobGp5I5FEKQ7TYUbFmt6UIXQ%3D%3D

Meaningful-Use-Audit

Lawyer: Fraud crackdown on physicians ramping up, so be prepared

http://www.healthcarefinancenews.com/news/lawyer-fraud-crackdown-physicians-ramping-so-be-prepared?mkt_tok=3RkMMJWWfF9wsRohu67OZKXonjHpfsX57u4rUa6zlMI%2F0ER3fOvrPUfGjI4GSctjI%2BSLDwEYGJlv6SgFQ7LHMbpszbgPUhM%3D

The healthcare industry is now getting the scrutiny that financial institutions and other publicly traded companies have experienced, said Phil Bezanson, a partner at Bracewell & Giuliani in Houston.

The healthcare industry is now getting the scrutiny that financial institutions and other publicly traded companies have experienced.

OIG warns physicians of fraud over compensation packages

http://www.healthcarefinancenews.com/news/oig-warns-physicians-fraud-over-compensation-packages?mkt_tok=3RkMMJWWfF9wsRogs6nAZKXonjHpfsX57u4rUa6zlMI%2F0ER3fOvrPUfGjI4GTsNrI%2BSLDwEYGJlv6SgFQ7LHMbpszbgPUhM%3D

Based on recent settlements with 12 physicians over violations of the anti-kickback statute, the Office of the Inspector General is urging physicians who enter into medical directorships to ensure the arrangements reflect fair market value for services.

Based on recent settlements with 12 physicians over violations of the anti-kickback statute, the Office of the Inspector General is urging physicians who enter into medical directorships to ensure the arrangements reflect fair market value for services.

CMS, Rural Care Advocates Rip OIG Report Targeting Swing Beds

http://www.healthleadersmedia.com/content/COM-314139/CMS-Rural-Care-Advocates-Rip-OIG-Report-Targeting-Swing-Beds

OIG: Medicare took a haircut on cardiac device replacements

http://www.fiercehealthpayer.com/antifraud/story/oig-medicare-took-haircut-cardiac-device-replacements/2014-11-17

FierceHealthPayerAntiFraud

Quantifying and addressing improper payments for Medicare evaluation and management services

http://www.sheppardhealthlaw.com/2014/06/articles/centers-for-medicare-and-medicaid-services-cms/quantifying-and-addressing-improper-payments-for-medicare-evaluation-and-management-services/

Healthcare Law Blog