Unfortunately, objective media coverage and comparisons of single-payer public health care with our current profit-driven corporate system are almost non-existent at this time.
George Seldes once said, “Journalism’s job is not impartial ‘balanced’ reporting. Journalism’s job is to tell the people what is really going on.”
Truth Emergency US
By Peter Phillips and David Kubiak
Many economists now doubt that government measures can prevent a major recession given the severe slump in the housing market, the subprime mortgage crisis, growing unemployment, declining consumer spending, and record high oil prices. Even harder times for working people are undoubtedly at hand, yet mainstream corporate media continues to lavish more attention on the Super Bowl and celebrity misadventures than measures to protect Americans from grave personal economic harm. We are spun, mislead, propagandized and amused to death by our media conglomerates and as a result the US has become the best entertained and least informed society in the world.
There is a literal truth emergency in the United States, not only regarding distant wars, torture camps, and doctored intelligence, but also around issues that most intimately impact our lives at home. For example, few Americans know that there has been a thirty-five year decline in real wages for most workers in the country, while the top 10% now enjoy unparalleled wealth with strikingly low tax burdens.
George Seldes once said, “Journalism’s job is not impartial ‘balanced’ reporting. Journalism’s job is to tell the people what is really going on.” Michael Moore’s top-grossing movie Sicko is one example of telling the people what is really going on. Health care activists know that US health insurance is an extremely large and obscenely lucrative industry with the top nine companies “earning” $93 billion in profits in 2006 alone. The health-care industry represents the country’s third-largest economic sector, trailing only energy and retail among the 1,000 largest US firms.
Nevertheless, 16%of Americans still have no health insurance whatsoever and that number will not soon decline, as insurance costs continue to rise two to three times faster than inflation. The consequences are immediate and tragic. Unpaid medical bills are now the number one cause of personal bankruptcy in the country, and the Institute of Medicine estimates that nearly eighteen thousand Americans die prematurely each year because they lack coverage and access to adequate care.
US private health care services differ markedly from other industrialized countries where single payer systems provide everyone with medical care as a basic human right. Unfortunately, objective media coverage and comparisons of single-payer public health care with our current profit-driven corporate system are almost non-existent at this time. To protect their bloated bottom lines, private insurance companies and HMOs invest heavily in lobbyists and corporate-friendly political candidates that promote their “indispensable” role in any future health care reforms. Besides their insider political influence, these firms deploy massive advertising budgets to discourage media investigations of the economic interests shaping our health policies today
Tens of thousands of American engaged in various social justice issues constantly witness how corporate media marginalize, denigrate or simply ignore their concerns. Activist groups working on issues like 9/11 truth, election fraud, impeachment, war propaganda, civil liberties/torture, and many corporate-caused environmental crises have been systematically excluded from mainstream news and the national conversation leading to a genuine truth emergency in the country as a whole.
Tuesday, September 30, 2008
Drug manufacturer reaches $425 million fraud settlement
Drug manufacturer reaches $425 million fraud settlement
BY DREW SMITH
HARTFORD, Conn. (Legal Newsline) -- Cephalon, a Frazer, Pa.-based drug manufacturer, has announced a $425 million Medicaid fraud settlement for off-label drug marketing.
After a four-year investigation by federal and state authorities, the company was found to have marketed three drugs -- Actiq, Gabitril and Provigil -- for un-approved uses.
"Cephalon put profits over patients -- illegally promoting drugs at any cost to patients, and endangering public safety," Connecticut Attorney General Richard Blumenthal said in a statement.
Blumenthal's office participated in the investigation and settled a separate suit with Cephalon for $6.15 million.
"We are pleased to have these long-standing matters behind us, while preserving our ability to participate in all federal and state health care programs, thereby maintaining the access of patients in those programs to our medications," said Jerry Pappert, executive VP and general counsel for Cephalon.
Actiq is a pain medication with potency 100 times stronger than morphine. It was designed to treat cancer patients, but Cephalon was accused of marketing the drug to "virtually any physician who could treat chronic pain."
Gabitril is a drug that was meant to treat seizures but was found to actually cause seizures when prescribed off-label to patients who were not epileptic. After Cephalon's aggressive promotion, sales of the drug grew from $4.3 million in 2000 to $66.5 million in 2005.
In addition to paying the $425 million fine to federal authorities and $6.15 million to Connecticut, the company must also pay $12 million in accrued interest. Cephalon must also plead guilty to a misdemeanor violation and enter into a five-year Corporate Integrity Agreement.
http://www.legalnewsline.com/news/216160-drug-manufacturer-reaches-425-million-fraud-settlement
BY DREW SMITH
HARTFORD, Conn. (Legal Newsline) -- Cephalon, a Frazer, Pa.-based drug manufacturer, has announced a $425 million Medicaid fraud settlement for off-label drug marketing.
After a four-year investigation by federal and state authorities, the company was found to have marketed three drugs -- Actiq, Gabitril and Provigil -- for un-approved uses.
"Cephalon put profits over patients -- illegally promoting drugs at any cost to patients, and endangering public safety," Connecticut Attorney General Richard Blumenthal said in a statement.
Blumenthal's office participated in the investigation and settled a separate suit with Cephalon for $6.15 million.
"We are pleased to have these long-standing matters behind us, while preserving our ability to participate in all federal and state health care programs, thereby maintaining the access of patients in those programs to our medications," said Jerry Pappert, executive VP and general counsel for Cephalon.
Actiq is a pain medication with potency 100 times stronger than morphine. It was designed to treat cancer patients, but Cephalon was accused of marketing the drug to "virtually any physician who could treat chronic pain."
Gabitril is a drug that was meant to treat seizures but was found to actually cause seizures when prescribed off-label to patients who were not epileptic. After Cephalon's aggressive promotion, sales of the drug grew from $4.3 million in 2000 to $66.5 million in 2005.
In addition to paying the $425 million fine to federal authorities and $6.15 million to Connecticut, the company must also pay $12 million in accrued interest. Cephalon must also plead guilty to a misdemeanor violation and enter into a five-year Corporate Integrity Agreement.
http://www.legalnewsline.com/news/216160-drug-manufacturer-reaches-425-million-fraud-settlement
Sunday, September 28, 2008
Prosecutors began their investigation after several U.S. employees of Swiss-based Serono claimed fraud.
"...president of a medical device company was sentenced Wednesday to three years probation and fined $10,000 for plotting ..."
Serono and its U.S. subsidiaries agreed in October 2005 to pay $704 million to resolve civil and criminal charges.
Executive sentenced in Serono fraud case
By Jay Lindsay, Associated PressWriter09.25.2008
Categories AP Business Business & Finance conspiracy Corporate management Court Proceedings crime Drug approvals General news Government and politics health Medical equipment and supplies manufacturing Technology Weight loss technologies
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The president of a medical device company was sentenced Wednesday to three years probation and fined $10,000 for plotting with Swiss-based Serono Laboratories to increase sales of an AIDS drug by manipulating a test for AIDS patients.
Rudolph Liedtke, president of Michigan-based RJL Sciences, pleaded guilty to conspiracy in 2005 for making and selling a software package in a device that Serono used to diagnose AIDS "wasting," an often fatal condition involving severe weight loss.
Prosecutors said the device diagnosed wasting even without weight loss so that Serono could increase sales of its drug Serostim. Demand for the drug had dropped in the late 1990s with the advent of "cocktails" of AIDS drugs that prevented wasting.
After Liedtke's cooperation with federal authorities, Serono and its U.S. subsidiaries agreed in October 2005 to pay $704 million to resolve civil and criminal charges.
On Wednesday, prosecutors asked U.S. District Judge Edward Harrington to sentence Liedtke to a prison sentence of just less than 3½ years. But Harrington refused, citing the case of Dr. Norma Muurahainen, who worked as a medical director for Serono and pleaded guilty to disseminating an adulterated device, but does not face prison time.
"(Liedtke) cooperated for three years. The other person, who in my judgment is equally culpable, did not," Harrington said. "It would have been a gross disparity to give him 41 months while the doctor walks."
Liedtke, 67, and his attorney, Robert Kalec, declined comment after the hearing. Assistant U.S. Attorney Mary Elizabeth Carmody and U.S. Attorney Michael Sullivan declined comment.
As part of the plea deal, prosecutors had originally agreed to a shorter sentence than they recommended Wednesday. But Carmody said that after Liedtke pleaded guilty in April 2005, he continued selling his company's device, which had not been approved by the Food and Drug Administration.
"Our position before the court would be different had he not continued the crime after he had pled guilty," Carmody said. "How does society tolerate, how does the court tolerate this kind of behavior? How does the court know that this defendant is not going to walk out the door and do it again? That is his history."
Kalec said he couldn't justify what his client did after his guilty plea. But he said that Liedtke's wrongdoing "paled in comparison" to others in the case, and added his company's profits were minuscule next to Serono's. He argued that without Liedtke's extensive cooperation with prosecutors, Serono would not have agreed to the huge penalty, the third-largest recovery in a health care fraud case in U.S. history.
Kalec asked Harrington to sentence Liedtke to probation, arguing that Carmody's concern that Liedtke would repeat his crime was unfounded.
"How do we know he won't go out and do it again? If he's on probation, the court continues to have a hammer over his head to ensure that he doesn't," Kalec said.
In brief comments before the court, Liedtke apologized for continuing to sell the device after his guilty plea.
"I'm just very, very sorry," he said.
Serono began marketing Serostim in 1996. But demand for the drug fell off sharply in the late 1990s after"cocktails" of AIDS drugs that made patients less susceptible to wasting hit the market. Serono then conspired with RJL Sciences to create a market for Serostim by selling a software package called SomaScan, which was used to diagnose AIDS wasting, but was not approved by the Food and Drug Administration for that use.
The cost of many of the prescriptions for Serostim, $21,000 for 12 weeks of treatment, was paid by Medicaid. Prosecutors began their investigation after several U.S. employees of Swiss-based Serono claimed fraud.
Serono paid a criminal fine of $136.9 million and civil penalties of $567 million, and pleaded guilty to federal conspiracy charges.
____
AP Legal Affairs Writer Denise Lavoie contributed to this report from Boston
Serono and its U.S. subsidiaries agreed in October 2005 to pay $704 million to resolve civil and criminal charges.
Executive sentenced in Serono fraud case
By Jay Lindsay, Associated PressWriter09.25.2008
Categories AP Business Business & Finance conspiracy Corporate management Court Proceedings crime Drug approvals General news Government and politics health Medical equipment and supplies manufacturing Technology Weight loss technologies
Comments 0
The president of a medical device company was sentenced Wednesday to three years probation and fined $10,000 for plotting with Swiss-based Serono Laboratories to increase sales of an AIDS drug by manipulating a test for AIDS patients.
Rudolph Liedtke, president of Michigan-based RJL Sciences, pleaded guilty to conspiracy in 2005 for making and selling a software package in a device that Serono used to diagnose AIDS "wasting," an often fatal condition involving severe weight loss.
Prosecutors said the device diagnosed wasting even without weight loss so that Serono could increase sales of its drug Serostim. Demand for the drug had dropped in the late 1990s with the advent of "cocktails" of AIDS drugs that prevented wasting.
After Liedtke's cooperation with federal authorities, Serono and its U.S. subsidiaries agreed in October 2005 to pay $704 million to resolve civil and criminal charges.
On Wednesday, prosecutors asked U.S. District Judge Edward Harrington to sentence Liedtke to a prison sentence of just less than 3½ years. But Harrington refused, citing the case of Dr. Norma Muurahainen, who worked as a medical director for Serono and pleaded guilty to disseminating an adulterated device, but does not face prison time.
"(Liedtke) cooperated for three years. The other person, who in my judgment is equally culpable, did not," Harrington said. "It would have been a gross disparity to give him 41 months while the doctor walks."
Liedtke, 67, and his attorney, Robert Kalec, declined comment after the hearing. Assistant U.S. Attorney Mary Elizabeth Carmody and U.S. Attorney Michael Sullivan declined comment.
As part of the plea deal, prosecutors had originally agreed to a shorter sentence than they recommended Wednesday. But Carmody said that after Liedtke pleaded guilty in April 2005, he continued selling his company's device, which had not been approved by the Food and Drug Administration.
"Our position before the court would be different had he not continued the crime after he had pled guilty," Carmody said. "How does society tolerate, how does the court tolerate this kind of behavior? How does the court know that this defendant is not going to walk out the door and do it again? That is his history."
Kalec said he couldn't justify what his client did after his guilty plea. But he said that Liedtke's wrongdoing "paled in comparison" to others in the case, and added his company's profits were minuscule next to Serono's. He argued that without Liedtke's extensive cooperation with prosecutors, Serono would not have agreed to the huge penalty, the third-largest recovery in a health care fraud case in U.S. history.
Kalec asked Harrington to sentence Liedtke to probation, arguing that Carmody's concern that Liedtke would repeat his crime was unfounded.
"How do we know he won't go out and do it again? If he's on probation, the court continues to have a hammer over his head to ensure that he doesn't," Kalec said.
In brief comments before the court, Liedtke apologized for continuing to sell the device after his guilty plea.
"I'm just very, very sorry," he said.
Serono began marketing Serostim in 1996. But demand for the drug fell off sharply in the late 1990s after"cocktails" of AIDS drugs that made patients less susceptible to wasting hit the market. Serono then conspired with RJL Sciences to create a market for Serostim by selling a software package called SomaScan, which was used to diagnose AIDS wasting, but was not approved by the Food and Drug Administration for that use.
The cost of many of the prescriptions for Serostim, $21,000 for 12 weeks of treatment, was paid by Medicaid. Prosecutors began their investigation after several U.S. employees of Swiss-based Serono claimed fraud.
Serono paid a criminal fine of $136.9 million and civil penalties of $567 million, and pleaded guilty to federal conspiracy charges.
____
AP Legal Affairs Writer Denise Lavoie contributed to this report from Boston
healthcare workers voted by more than a 3-to-1 margin to be represented by SEIU United Healthcare
California Assembly Speaker pro Tempore Sally Lieber (D-San Jose) reacted to the vote of healthcare workers at Stanford hospitals in favor of union representation.
In an election conducted by the National Labor Relations Board, healthcare workers voted by more than a 3-to-1 margin to be represented by SEIU United Healthcare Workers - West (UHW) at Stanford Hospital & Clinics (SHC) and Lucile Packard Children’s Hospital (LPCH). Today’s vote garnered an even wider margin of support than when workers first voted for union representation in 1998.
“I am very pleased by the outcome of this vote,” said Lieber. “The overwhelming show of support for union representation should give the community confidence that the voice of front-line caregivers will be heard.”
Lieber continued, “Clearly this is an important decision for these workers and their families-but also for the community that relies on Stanford Hospital and Lucile Packard Children’s Hospital for care.”
SEIU-UHW will be representing approximately 1,450 healthcare workers at the Stanford hospitals.
A month ago, Stanford physically blocked Speaker pro Tem Lieber and union members from entering the hospital to deliver an open letter signed by workers asking Stanford management to remain neutral and open-minded toward employees seeking union representation.
California State Assembly
Other news:
In an election conducted by the National Labor Relations Board, healthcare workers voted by more than a 3-to-1 margin to be represented by SEIU United Healthcare Workers - West (UHW) at Stanford Hospital & Clinics (SHC) and Lucile Packard Children’s Hospital (LPCH). Today’s vote garnered an even wider margin of support than when workers first voted for union representation in 1998.
“I am very pleased by the outcome of this vote,” said Lieber. “The overwhelming show of support for union representation should give the community confidence that the voice of front-line caregivers will be heard.”
Lieber continued, “Clearly this is an important decision for these workers and their families-but also for the community that relies on Stanford Hospital and Lucile Packard Children’s Hospital for care.”
SEIU-UHW will be representing approximately 1,450 healthcare workers at the Stanford hospitals.
A month ago, Stanford physically blocked Speaker pro Tem Lieber and union members from entering the hospital to deliver an open letter signed by workers asking Stanford management to remain neutral and open-minded toward employees seeking union representation.
California State Assembly
Other news:
Saturday, September 27, 2008
Supreme Court upholds state Medicaid fraud decision
Connecticut Supreme Court upholds state Medicaid fraud decision
BY DREW SMITH
HARTFORD, Conn. (Legal Newsline)--The Connecticut Supreme Court has upheld a ruling made by the state's Department of Social Services against a Farmington-based company for defrauding the state's Medicaid program.
Attorney General Richard Blumenthal and DSS Commissioner Michael Starkowski praised the decision, which orders Goldstar Medical, Inc., to pay the state $198,193 in restitution and suspended the company's owner, Donald Bouchard.
"This victory ends attempts by Goldstar and Bouchard to evade accountability for health care fraud. Now they must refund taxpayers for their wrongdoing," Blumenthal said.
Goldstar, a company that supplies oxygen to nursing homes and other long-term care facilities, was subject of a 2005 investigation that ultimately found the company defrauded the Medicaid program by submitting payment claims for uncovered services and services not ordered by a physician, double-billing and illegal altering documents.
Bouchard has attempted to fight the state order since 2005.
"The Supreme Court -- upholding the state's order -- has roundly rejected efforts to avoid refunds and other remedies," Blumenthal said.
According to Blumthal's office, Goldstar altered documents in order to show patients needed the company's oxygen supplies instead of those included in the patient's nursing home rate. This caused Medicaid to pay Goldstar for unneeded oxygen.
"While the great majority of vendors in the Medicaid program are honest and forthright, Connecticut and other states must constantly employ fraud prevention and enforcement measures to root out incidents of abuse," Starkowski said.
Filed Under: State Supreme Courts
BY DREW SMITH
HARTFORD, Conn. (Legal Newsline)--The Connecticut Supreme Court has upheld a ruling made by the state's Department of Social Services against a Farmington-based company for defrauding the state's Medicaid program.
Attorney General Richard Blumenthal and DSS Commissioner Michael Starkowski praised the decision, which orders Goldstar Medical, Inc., to pay the state $198,193 in restitution and suspended the company's owner, Donald Bouchard.
"This victory ends attempts by Goldstar and Bouchard to evade accountability for health care fraud. Now they must refund taxpayers for their wrongdoing," Blumenthal said.
Goldstar, a company that supplies oxygen to nursing homes and other long-term care facilities, was subject of a 2005 investigation that ultimately found the company defrauded the Medicaid program by submitting payment claims for uncovered services and services not ordered by a physician, double-billing and illegal altering documents.
Bouchard has attempted to fight the state order since 2005.
"The Supreme Court -- upholding the state's order -- has roundly rejected efforts to avoid refunds and other remedies," Blumenthal said.
According to Blumthal's office, Goldstar altered documents in order to show patients needed the company's oxygen supplies instead of those included in the patient's nursing home rate. This caused Medicaid to pay Goldstar for unneeded oxygen.
"While the great majority of vendors in the Medicaid program are honest and forthright, Connecticut and other states must constantly employ fraud prevention and enforcement measures to root out incidents of abuse," Starkowski said.
Filed Under: State Supreme Courts
Tuesday, September 23, 2008
$15 M Medicaid fraud lawsuit dismissed against medical center
$15 M Medicaid fraud lawsuit dismissed against medical center
East Texas Medical Center Regional Healthcare System
9/22/2008 3:00 PM
By Michelle Massey, Texarkana Bureau
MARSHALL - A federal judge recently granted a summary judgment in a case alleging a health care system submitted false claims to Medicaid.
U. S. District Judge T. John Ward granted the motion for summary in late August, dismissing a lawsuit against East Texas Medical Center Regional Healthcare System.
The lawsuit alleged the company violated the False Claims Act by submitting claims to the federal government for over $15 million of federal Medicaid matching funds.
The lawsuit was filed under seal on June 8, 2005, but when the United States declined to intervene, the court unsealed the action on Feb. 6, 2007.
According to court records, East Texas Medical Center Regional Healthcare System is a hospital company that owns and operates private hospital facilities in East Texas, including co-defendant East Texas Medical Center Athens.
The suit filed against the defendants argues that the companies "devised and implemented a scheme to fraudulently receive additional Medicaid matching funds from the United States by illegally abusing the intergovernmental transfers procedure for the Medicaid Upper Payment Limits Program."
The program allows states to reimburse public rural hospitals for specific uncompensated care provided under Medicaid. The reimbursement is an amount equal to what Medicare would have paid for the same service.
Intergovernmental transfers -- transfers made from one government agency to another -- are used to partially fund the state's contribution to the upper payments limit program and then can be used to claim additional federal monies.
To participate in the program, federal regulations require states to separate the hospitals by facility type because public hospitals are eligible for a higher percentage of reimbursement than private non-profit hospitals.
There are three facility types: state government-owned or operated, non-state government-owned or operated,and privately owned and operated facilities.
The private, non-profit organization ETMC operates East Texas Medical Center Athens but the facility is owned by Henderson County and then leased to Henderson County Hospital Authority, who subleases it to ETMC.
In 2002, the entity selected by the state to develop the upper payments limit program, The Texas Organization of Rural and Community Hospitals (TORCH) advised East Texas Medical Center Athens that it qualified for the program and could receive significant additional funding.
The lawsuit asserts that East Texas Medical Center Athens is actually a private hospital and obtaining reimbursement at a higher percentage level is a false claim under the False Claims Act.
Specifically, the lawsuit alleges that the defendant "masqueraded" as a public hospital and then knowingly received the higher reimbursement.
The defendants argue that its lease agreement with the county makes its fall under the county-owned facility operated by a private company. Further, the defendants relied on TORCH's communication that it qualified under the program, although TORCH had a significant financial interest with their participation in the program.
Within Judge Ward's opinion, he failed to decide whether the defendant is a public hospital or whether the funds are prohibited.
Judge Ward emphasizes that a "private hospital is defined as 'owned and operated' privately, and a public hospital is 'owned or operated' by the government."
However, Judge Ward did find that the defendants did not knowingly make a false claim to the government.
Judge Ward wrote, that the defendants' "reliance on TORCH and its attorneys was reasonable. East Texas Medical Center Athens' failure to seek independent legal advice under these facts does not rise to the level of reckless disregard needed for a FCA claim. At most, it would constitute negligence, which is insufficient to assert a claim under the FCA."
With the August Order, Judge Ward grants the defendants' motion for summary judgment and dismisses the case.
Case No 2:05cv00216
East Texas Medical Center Regional Healthcare System
9/22/2008 3:00 PM
By Michelle Massey, Texarkana Bureau
MARSHALL - A federal judge recently granted a summary judgment in a case alleging a health care system submitted false claims to Medicaid.
U. S. District Judge T. John Ward granted the motion for summary in late August, dismissing a lawsuit against East Texas Medical Center Regional Healthcare System.
The lawsuit alleged the company violated the False Claims Act by submitting claims to the federal government for over $15 million of federal Medicaid matching funds.
The lawsuit was filed under seal on June 8, 2005, but when the United States declined to intervene, the court unsealed the action on Feb. 6, 2007.
According to court records, East Texas Medical Center Regional Healthcare System is a hospital company that owns and operates private hospital facilities in East Texas, including co-defendant East Texas Medical Center Athens.
The suit filed against the defendants argues that the companies "devised and implemented a scheme to fraudulently receive additional Medicaid matching funds from the United States by illegally abusing the intergovernmental transfers procedure for the Medicaid Upper Payment Limits Program."
The program allows states to reimburse public rural hospitals for specific uncompensated care provided under Medicaid. The reimbursement is an amount equal to what Medicare would have paid for the same service.
Intergovernmental transfers -- transfers made from one government agency to another -- are used to partially fund the state's contribution to the upper payments limit program and then can be used to claim additional federal monies.
To participate in the program, federal regulations require states to separate the hospitals by facility type because public hospitals are eligible for a higher percentage of reimbursement than private non-profit hospitals.
There are three facility types: state government-owned or operated, non-state government-owned or operated,and privately owned and operated facilities.
The private, non-profit organization ETMC operates East Texas Medical Center Athens but the facility is owned by Henderson County and then leased to Henderson County Hospital Authority, who subleases it to ETMC.
In 2002, the entity selected by the state to develop the upper payments limit program, The Texas Organization of Rural and Community Hospitals (TORCH) advised East Texas Medical Center Athens that it qualified for the program and could receive significant additional funding.
The lawsuit asserts that East Texas Medical Center Athens is actually a private hospital and obtaining reimbursement at a higher percentage level is a false claim under the False Claims Act.
Specifically, the lawsuit alleges that the defendant "masqueraded" as a public hospital and then knowingly received the higher reimbursement.
The defendants argue that its lease agreement with the county makes its fall under the county-owned facility operated by a private company. Further, the defendants relied on TORCH's communication that it qualified under the program, although TORCH had a significant financial interest with their participation in the program.
Within Judge Ward's opinion, he failed to decide whether the defendant is a public hospital or whether the funds are prohibited.
Judge Ward emphasizes that a "private hospital is defined as 'owned and operated' privately, and a public hospital is 'owned or operated' by the government."
However, Judge Ward did find that the defendants did not knowingly make a false claim to the government.
Judge Ward wrote, that the defendants' "reliance on TORCH and its attorneys was reasonable. East Texas Medical Center Athens' failure to seek independent legal advice under these facts does not rise to the level of reckless disregard needed for a FCA claim. At most, it would constitute negligence, which is insufficient to assert a claim under the FCA."
With the August Order, Judge Ward grants the defendants' motion for summary judgment and dismisses the case.
Case No 2:05cv00216
Thursday, September 18, 2008
Fraud & Compliance Forum in Baltimore next month.
FORT LAUDERDALE, FL (September 17, 2008) Health care fraud blog publisher, attorney Robert David Malove, will be attending the 2008 Fraud & Compliance Forum in Baltimore next month.
The AHLA/HCCA Fraud & Compliance Forum will provide practical guidance on the pressing legal and compliance issues that have arisen in the last twelve months. For health lawyers, the program will highlight the most important legal developments in areas such as Stark, the False Claims Act, and the Anti-Kickback Statute. For compliance officers, the conference will cover important issues such as Part D compliance plans, compliance effectiveness, and fraud and abuse. The program’s uniqueness stems not only from the important content for health lawyers and compliance officers but also from the additional value of bringing together legal counsel and compliance officers in one educational arena. The networking opportunities and synergistic advances in fraud and abuse compliance make this program an essential educational forum for both health lawyers and compliance officers.
The Fraud & Compliance Forum is jointly sponsored by the Health Care Compliance Association (HCCA) and the American Health Lawyers Association (AHLA). It includes an explicit designation of each session as “compliance focused” or “legal focused.” The Planning Committee has included enough sessions in each designation that an individual could attend all “compliance” sessions or all “legal” sessions for the entire program. Yet an attendee also has the option of selecting a diversity of sessions and networking with an expanded group of individuals. The Fraud & Compliance Forum has the benefit of combining the quality of HCCA and AHLA sessions with the expanded networking power of a combined program.
Program Goals and Objectives:
Participants at the AHLA/HCCA Fraud & Compliance Forum will:
* Gain a greater understanding of the full nature of the various regulations governing the delivery of healthcare (Stark, False Claims Act)
* Recognize emerging regulatory trends that will affect legal and compliance practices in healthcare
* Network with peers and learn about the challenges and risk areas faced by a wide variety of healthcare settings (hospitals, academic medical centers, physician practices, long-term care providers, pharmaceutical manufacturers)
* Recognize the common issues faced by compliance and legal professionals, the roles each play in ensuring compliance and ways in which they can effectively work together
The AHLA/HCCA Fraud & Compliance Forum will provide practical guidance on the pressing legal and compliance issues that have arisen in the last twelve months. For health lawyers, the program will highlight the most important legal developments in areas such as Stark, the False Claims Act, and the Anti-Kickback Statute. For compliance officers, the conference will cover important issues such as Part D compliance plans, compliance effectiveness, and fraud and abuse. The program’s uniqueness stems not only from the important content for health lawyers and compliance officers but also from the additional value of bringing together legal counsel and compliance officers in one educational arena. The networking opportunities and synergistic advances in fraud and abuse compliance make this program an essential educational forum for both health lawyers and compliance officers.
The Fraud & Compliance Forum is jointly sponsored by the Health Care Compliance Association (HCCA) and the American Health Lawyers Association (AHLA). It includes an explicit designation of each session as “compliance focused” or “legal focused.” The Planning Committee has included enough sessions in each designation that an individual could attend all “compliance” sessions or all “legal” sessions for the entire program. Yet an attendee also has the option of selecting a diversity of sessions and networking with an expanded group of individuals. The Fraud & Compliance Forum has the benefit of combining the quality of HCCA and AHLA sessions with the expanded networking power of a combined program.
Program Goals and Objectives:
Participants at the AHLA/HCCA Fraud & Compliance Forum will:
* Gain a greater understanding of the full nature of the various regulations governing the delivery of healthcare (Stark, False Claims Act)
* Recognize emerging regulatory trends that will affect legal and compliance practices in healthcare
* Network with peers and learn about the challenges and risk areas faced by a wide variety of healthcare settings (hospitals, academic medical centers, physician practices, long-term care providers, pharmaceutical manufacturers)
* Recognize the common issues faced by compliance and legal professionals, the roles each play in ensuring compliance and ways in which they can effectively work together
Hancock kept prescribing drugs with high addiction risks
A former Hawkins County doctor was arrested in Texas Wednesday on indictments of health care fraud, unlawfully dispensing controlled substances, money laundering, income tax evasion and failure to file tax returns.
John Theodore Hancock, 47, was indicted by a federal grand jury in Greeneville, Tennessee, on September 9.
While Hancock was licensed to practice in Tennessee, the indictment alleges he operated "Hancock Family Medicine" and "Dr. John T. Hancock Family Medicine" in Mooresburg.
Hancock is accused of improperly prescribing such substances as methadone, morphine, oxycodone, hydrocodone, and benzodiazepines for patients he didn't examine.
He's also accused of charging patients $80 to $100 in cash for each visit.
Investigators believe Hancock kept prescribing drugs with high addiction risks, even after he learned some patients were doctor shopping or selling their drugs.
The indictment also accuses Hancock of writing prescriptions patients would bring back for his personal use.
Hancock agreed to surrender his registration with the DEA to prescribe controlled substances in December 2003, then got another doctor to issue prescriptions for his patients, according to the indictment.
Since most of the prescriptions were paid for through TennCare, the indictment charges Hancock with trying to defraud that program.
Investigators believe five patients, identified in the indictment, died due to Hancock's prescribing practices.
Hancock is also charged with making financial transactions using money from health care fraud and unlawfully dispensed substances. One instance involves $16,480 in cash in February 2005. Another involves $18,552 in cash in April 2005.
The indictment alleges Hancock evaded paying income tax for 1994 and 1995 and failed to file tax returns from 2002 through 2005. During that time, investigators think he had a gross income of over $1 million.
Hancock was released on bond when he appeared in U.S. District Court in Marshall, Texas Wednesday. He's due in federal court in Greeneville on September 24.
If convicted, Hancock faces possible life in prison and fines of more than $2.5 million.
John Theodore Hancock, 47, was indicted by a federal grand jury in Greeneville, Tennessee, on September 9.
While Hancock was licensed to practice in Tennessee, the indictment alleges he operated "Hancock Family Medicine" and "Dr. John T. Hancock Family Medicine" in Mooresburg.
Hancock is accused of improperly prescribing such substances as methadone, morphine, oxycodone, hydrocodone, and benzodiazepines for patients he didn't examine.
He's also accused of charging patients $80 to $100 in cash for each visit.
Investigators believe Hancock kept prescribing drugs with high addiction risks, even after he learned some patients were doctor shopping or selling their drugs.
The indictment also accuses Hancock of writing prescriptions patients would bring back for his personal use.
Hancock agreed to surrender his registration with the DEA to prescribe controlled substances in December 2003, then got another doctor to issue prescriptions for his patients, according to the indictment.
Since most of the prescriptions were paid for through TennCare, the indictment charges Hancock with trying to defraud that program.
Investigators believe five patients, identified in the indictment, died due to Hancock's prescribing practices.
Hancock is also charged with making financial transactions using money from health care fraud and unlawfully dispensed substances. One instance involves $16,480 in cash in February 2005. Another involves $18,552 in cash in April 2005.
The indictment alleges Hancock evaded paying income tax for 1994 and 1995 and failed to file tax returns from 2002 through 2005. During that time, investigators think he had a gross income of over $1 million.
Hancock was released on bond when he appeared in U.S. District Court in Marshall, Texas Wednesday. He's due in federal court in Greeneville on September 24.
If convicted, Hancock faces possible life in prison and fines of more than $2.5 million.
119 USD million Medicare fraud ring pleaded guilty
I wonder how much they will have to pay back?
What deal did the government make?
Thursday, September 18th, 2008
A Miami physician’s assistant who trained doctors how to prescribe obsolete HIV therapy in a $119 million Medicare fraud ring pleaded guilty Thursday in a federal case that reverberates from South Florida to Cuba.
Related News
Miami HIV Clinic Administrator Pleads Guilty for Role in a $14 Million Medicare Fraud Scheme
Miami Physician and HIV Clinic Administrator Plead Guilty for Their Roles in a $37 Million Medicare Fraud Scheme
Dublin Doctor Who Defrauded Medicaid And Medicare Pleads Guilty To Health Care Fraud
What deal did the government make?
Thursday, September 18th, 2008
A Miami physician’s assistant who trained doctors how to prescribe obsolete HIV therapy in a $119 million Medicare fraud ring pleaded guilty Thursday in a federal case that reverberates from South Florida to Cuba.
Related News
Miami HIV Clinic Administrator Pleads Guilty for Role in a $14 Million Medicare Fraud Scheme
Miami Physician and HIV Clinic Administrator Plead Guilty for Their Roles in a $37 Million Medicare Fraud Scheme
Dublin Doctor Who Defrauded Medicaid And Medicare Pleads Guilty To Health Care Fraud
HCA INC/TN Richard Rainwater & George W Bush
Person
CRAIG E. GARDELLA
Records 1 - 18 of 18.
Company Name Form Type Received Date View
COMMUNITY HEALTH SYSTEMS INC 8-K 7/30/2007
HCA INC/TN 8-K 11/3/2005
PSYCHIATRIC SOLUTIONS INC 8-K 12/28/2004
HCA INC/TN 8-K 11/10/2004 PSYCHIATRIC SOLUTIONS INC 10-Q 8/11/2004
RENAL CARE GROUP INC 8-K 4/16/2004
HEALTHCARE REALTY TRUST INC 10-Q 11/14/2003
HEALTHWAYS, INC 8-K/A 10/10/2003
RFS PARTNERSHIP LP 8-K 1/16/2003
RFS HOTEL INVESTORS INC 8-K 1/16/2003
NORTHWEST AIRLINES CORP 10-Q 11/6/2002
AUTOZONE INC 8-K 10/1/2002
BUCKEYE TECHNOLOGIES INC 10-K 9/20/2002
BUCKEYE TECHNOLOGIES INC 10-Q 5/14/2002
NORTHWEST AIRLINES CORP 10-K405 4/1/2002
RESORTQUEST INTERNATIONAL INC 10-Q 11/14/2001
THOMAS & BETTS CORP 10-Q 8/15/2001
BUCKEYE TECHNOLOGIES INC 10-Q 5/2/2001
CRAIG E. GARDELLA
Records 1 - 18 of 18.
Company Name Form Type Received Date View
COMMUNITY HEALTH SYSTEMS INC 8-K 7/30/2007
HCA INC/TN 8-K 11/3/2005
PSYCHIATRIC SOLUTIONS INC 8-K 12/28/2004
HCA INC/TN 8-K 11/10/2004 PSYCHIATRIC SOLUTIONS INC 10-Q 8/11/2004
RENAL CARE GROUP INC 8-K 4/16/2004
HEALTHCARE REALTY TRUST INC 10-Q 11/14/2003
HEALTHWAYS, INC 8-K/A 10/10/2003
RFS PARTNERSHIP LP 8-K 1/16/2003
RFS HOTEL INVESTORS INC 8-K 1/16/2003
NORTHWEST AIRLINES CORP 10-Q 11/6/2002
AUTOZONE INC 8-K 10/1/2002
BUCKEYE TECHNOLOGIES INC 10-K 9/20/2002
BUCKEYE TECHNOLOGIES INC 10-Q 5/14/2002
NORTHWEST AIRLINES CORP 10-K405 4/1/2002
RESORTQUEST INTERNATIONAL INC 10-Q 11/14/2001
THOMAS & BETTS CORP 10-Q 8/15/2001
BUCKEYE TECHNOLOGIES INC 10-Q 5/2/2001
"...largest health-care fraud settlement ever registered in the United States. "
The hospital agreed to return $25 million to the federal government
Ten years they were robbing Medicare and Tricare....and what do they have to pay?
The hospital will also have to pay another $26.6 million to cover Medicare and Medicaid reimbursements it received for treating thousands of patients for substance abuse using unregulated and unlicensed methods between 1994 and 2004.
Wednesday, September 17, 2008
Staten Island University Hospital to Pay $88.9M in Fraud Case - efluxmedia.com - 16 Sep 2008
New York’s Staten Island University Hospital will have to pay $88.9 million to federal and state authorities in the largest health-care fraud settlement ever registered in the United States.
A lawsuit filed in federal court in Brooklyn accused the hospital of fraudulently billing Medicare, Medicaid, and TRICARE, the insurance offered to military personnel, between 1994 and 2005.
The settlements stem from two False Claims Act suits filed by whistleblowers, as well as two investigations by the US Attorney’s Office and the state Attorney General’s Office. The fraud schemes date between 1994 and 2005, according to officials. Part of the settlements covers work done by Dr. Gilbert Lederman’s radiation oncology department.
"This was a hospital that sought to exploit the Medicare program and obtain millions of dollars in payments that it was not entitled to," said Richard Reich, lawyer for federal whistleblower Elizabeth Ryan, who brought the first case against Lederman and the hospital. Investigators in this case determined that the hospital used incorrect billing codes in cancer treatment from 1996 through 2004 to Medicare and TRICARE. The hospital agreed to return $25 million to the federal government. Ms. Ryan, the widow of a hospital’s patient, will receive $3.75 million.
The hospital will also have to pay another $26.6 million to cover Medicare and Medicaid reimbursements it received for treating thousands of patients for substance abuse using unregulated and unlicensed methods between 1994 and 2004.
A statement released by the hospital said: “We want to assure our patients and the communities we serve that SIUH will continue to deliver the same high-quality care that has enabled us to win coveted national awards.”
By Anna Boyd
Ten years they were robbing Medicare and Tricare....and what do they have to pay?
The hospital will also have to pay another $26.6 million to cover Medicare and Medicaid reimbursements it received for treating thousands of patients for substance abuse using unregulated and unlicensed methods between 1994 and 2004.
Wednesday, September 17, 2008
Staten Island University Hospital to Pay $88.9M in Fraud Case - efluxmedia.com - 16 Sep 2008
New York’s Staten Island University Hospital will have to pay $88.9 million to federal and state authorities in the largest health-care fraud settlement ever registered in the United States.
A lawsuit filed in federal court in Brooklyn accused the hospital of fraudulently billing Medicare, Medicaid, and TRICARE, the insurance offered to military personnel, between 1994 and 2005.
The settlements stem from two False Claims Act suits filed by whistleblowers, as well as two investigations by the US Attorney’s Office and the state Attorney General’s Office. The fraud schemes date between 1994 and 2005, according to officials. Part of the settlements covers work done by Dr. Gilbert Lederman’s radiation oncology department.
"This was a hospital that sought to exploit the Medicare program and obtain millions of dollars in payments that it was not entitled to," said Richard Reich, lawyer for federal whistleblower Elizabeth Ryan, who brought the first case against Lederman and the hospital. Investigators in this case determined that the hospital used incorrect billing codes in cancer treatment from 1996 through 2004 to Medicare and TRICARE. The hospital agreed to return $25 million to the federal government. Ms. Ryan, the widow of a hospital’s patient, will receive $3.75 million.
The hospital will also have to pay another $26.6 million to cover Medicare and Medicaid reimbursements it received for treating thousands of patients for substance abuse using unregulated and unlicensed methods between 1994 and 2004.
A statement released by the hospital said: “We want to assure our patients and the communities we serve that SIUH will continue to deliver the same high-quality care that has enabled us to win coveted national awards.”
By Anna Boyd
Friday, September 12, 2008
Tennesseans can get cash rewards for TennCare fraud tips that lead to convictions
Well this is a start tocombat the fraud, howweverwhat about all the money that was stolen HCA over the years?
Just the money that HCA settled 'out of court' for was a FRACTION, a FRACTION of what they STOLE! And were still allowed to continue UNINTERRUPTED BUSINESS as USUAL!
mentored by Rixchard Rainwater and friends!
How about HCA paying ALL of the money,that was stolen mind you, back to the people, not just the fraction the government settled for, buit ALL OF the LOOT BACK!
Man charged with TennCare fraud
NASHVILLE — A Rutherford County man is charged with using the TennCare medical benefits of another individual in order to get health-care treatment he would otherwise have to pay for.
The Office of Inspector General (OIG) and the Rutherford County Sheriff’s Department today announced the arrest of Steven M. Barrett, 19, of Murfreesboro.
An indictment charges Barrett with one count of TennCare fraud and using someone’s TennCare card in order to obtain treatment at a health-care provider’s office in Rutherford County.
“Health-care benefits are not transferable to another person — even in the private sector — and it’s especially egregious for someone to steal the benefits of a person who legitimately qualifies for TennCare,” Inspector General Deborah Y. Faulkner said.
Illegally obtaining TennCare medical benefits is a Class E felony that carries a maximum penalty of two years in prison per charge. District Attorney William Whitesell Jr. will prosecute.
The OIG, a law enforcement agency separate from TennCare, began full operation in February 2005 and has worked cases leading to the arrest of more than 760 individuals for TennCare fraud, with nearly $1 million paid in restitution to TennCare, and total estimated cost avoidance in TennCare of over $122 million, according to latest figures.
Through the OIG Cash for Tips Program established by the Legislature, Tennesseans can get cash rewards for TennCare fraud tips that lead to convictions. “Anyone can report suspected TennCare fraud by calling 1-800-433-3982 toll-free from anywhere in Tennessee, or log on to www.tncarefraud.tennessee.gov and follow the prompts that read “Report TennCare Fraud.”
Just the money that HCA settled 'out of court' for was a FRACTION, a FRACTION of what they STOLE! And were still allowed to continue UNINTERRUPTED BUSINESS as USUAL!
mentored by Rixchard Rainwater and friends!
How about HCA paying ALL of the money,that was stolen mind you, back to the people, not just the fraction the government settled for, buit ALL OF the LOOT BACK!
Man charged with TennCare fraud
NASHVILLE — A Rutherford County man is charged with using the TennCare medical benefits of another individual in order to get health-care treatment he would otherwise have to pay for.
The Office of Inspector General (OIG) and the Rutherford County Sheriff’s Department today announced the arrest of Steven M. Barrett, 19, of Murfreesboro.
An indictment charges Barrett with one count of TennCare fraud and using someone’s TennCare card in order to obtain treatment at a health-care provider’s office in Rutherford County.
“Health-care benefits are not transferable to another person — even in the private sector — and it’s especially egregious for someone to steal the benefits of a person who legitimately qualifies for TennCare,” Inspector General Deborah Y. Faulkner said.
Illegally obtaining TennCare medical benefits is a Class E felony that carries a maximum penalty of two years in prison per charge. District Attorney William Whitesell Jr. will prosecute.
The OIG, a law enforcement agency separate from TennCare, began full operation in February 2005 and has worked cases leading to the arrest of more than 760 individuals for TennCare fraud, with nearly $1 million paid in restitution to TennCare, and total estimated cost avoidance in TennCare of over $122 million, according to latest figures.
Through the OIG Cash for Tips Program established by the Legislature, Tennesseans can get cash rewards for TennCare fraud tips that lead to convictions. “Anyone can report suspected TennCare fraud by calling 1-800-433-3982 toll-free from anywhere in Tennessee, or log on to www.tncarefraud.tennessee.gov and follow the prompts that read “Report TennCare Fraud.”
Wednesday, September 10, 2008
CBO suggests.....
The federal budget deficit was $486 billion in the first 11 months of fiscal year 2008, CBO estimates, $212 billion more than the shortfall recorded over the same period last year. CBO anticipates that the government will realize a surplus in September, stemming from quarterly payments of estimated income taxes. The result will be a deficit in the vicinity of $400 billion for the fiscal year. CBO will release a new estimate of the 2008 deficit and updated baseline projections for fiscal years 2009–2018 on September 9.
The CBO,Congressional Budget Office, analyses and informs that the Health Care Cost, if not addressed in the very near future will be in a CRISIS!
Really? As if it is not already?
The biggest drivers in the CBO:
Medicare
Medicaid
Social Security
Study suggests health care fraud drives up medical costs
Birmingham Business Journal
Friday, September 5, 2008
Just take a look at some of the fraud listed in this blog.
The CBO,Congressional Budget Office, analyses and informs that the Health Care Cost, if not addressed in the very near future will be in a CRISIS!
Really? As if it is not already?
The biggest drivers in the CBO:
Medicare
Medicaid
Social Security
Study suggests health care fraud drives up medical costs
Birmingham Business Journal
Friday, September 5, 2008
Just take a look at some of the fraud listed in this blog.
Tuesday, September 9, 2008
"...health care fraud drives up medical costs" Really?
Friday, September 5, 2008
Study suggests health care fraud drives up medical costs
Birmingham Business Journal
While health care companies are spending billions on construction, a recent study has found that health care fraud may be one of the biggest factors driving up health care costs, to the tune of billions of dollars, new research indicates.
Resolved health care fraud cases alone in the previous decade involved $9.3 billion in damages paid to both federal and state government, according to researchers at Brigham and Women’s Hospital.
Results of the study are slated to be published in the Sept. 2 issue of the Annals of Internal Medicine.
But the researchers said the data suggest that there is likely much more unrecognized fraud still going on within the health care system, adding countless inefficiencies that drive up costs.
Study suggests health care fraud drives up medical costs
Birmingham Business Journal
While health care companies are spending billions on construction, a recent study has found that health care fraud may be one of the biggest factors driving up health care costs, to the tune of billions of dollars, new research indicates.
Resolved health care fraud cases alone in the previous decade involved $9.3 billion in damages paid to both federal and state government, according to researchers at Brigham and Women’s Hospital.
Results of the study are slated to be published in the Sept. 2 issue of the Annals of Internal Medicine.
But the researchers said the data suggest that there is likely much more unrecognized fraud still going on within the health care system, adding countless inefficiencies that drive up costs.
Friday, September 5, 2008
$9.3 billion recovered between 1996 and 2005...are you kidding?
Trillions have been stolen and this DOJ should be satsified with $9.3 billion recovered...give me a break!
WASHINGTON, D.C.
Whistle-blowers play large role in uncovering healthcare fraud
Insiders helped authorities recover more than $9.3 billion between 1996 and 2005. For their efforts, they get 15% to 25% of the amount reimbursed.
September 2, 2008
Insiders aid in healthcare fraud cases
Whistle-blowers have helped authorities recover at least $9.3 billion from healthcare providers accused of defrauding states and the federal government since 1996, according to an analysis of Justice Department records.
The department intensified efforts in the 1990s to combat healthcare fraud by using private citizens with inside knowledge of wrongdoing. They now initiate more than 90% of the department's lawsuits focusing on healthcare fraud.
Whistle-blowers start cases by filing a sealed complaint in federal court. The department investigates and can intervene, assuming the lead role in the lawsuit.
Whistle-blowers then get 15% to 25% of the amount recovered.
Of the $9.3 billion recovered between 1996 and 2005, whistle-blowers got more than $1 billion, analysts estimated, writing for the Annals of Internal Medicine. The analysts' estimates are conservative.
WASHINGTON, D.C.
Whistle-blowers play large role in uncovering healthcare fraud
Insiders helped authorities recover more than $9.3 billion between 1996 and 2005. For their efforts, they get 15% to 25% of the amount reimbursed.
September 2, 2008
Insiders aid in healthcare fraud cases
Whistle-blowers have helped authorities recover at least $9.3 billion from healthcare providers accused of defrauding states and the federal government since 1996, according to an analysis of Justice Department records.
The department intensified efforts in the 1990s to combat healthcare fraud by using private citizens with inside knowledge of wrongdoing. They now initiate more than 90% of the department's lawsuits focusing on healthcare fraud.
Whistle-blowers start cases by filing a sealed complaint in federal court. The department investigates and can intervene, assuming the lead role in the lawsuit.
Whistle-blowers then get 15% to 25% of the amount recovered.
Of the $9.3 billion recovered between 1996 and 2005, whistle-blowers got more than $1 billion, analysts estimated, writing for the Annals of Internal Medicine. The analysts' estimates are conservative.
Banks Are Uniquely Positioned to Prevent Health Care Fraud
How about Banks assist with Health Care Fraud? Perfect example is NCFE missing the Founder and CEO and also an "Executive" James K Happ.....the person who assisted GW Bush's ex-partner Richard Rainwater in the "PONZI SCHEME" as noted by Federal Prosecutors involved in the case they would like to to reference as "an end to an era".
Not so fast.....so much more to KNOW! James K Happ....(Smoking GUN)
Banks Are Uniquely Positioned to Prevent Health Care Fraud
By Matt Squire
Bank compliance professionals are in a prime position to uncover health care fraud if they are aware of the tell-tale signs and report the related suspicious activity to law enforcement, say fraud investigators.
Health care fraud accounts for around 10 percent or $100 billion of the $1 trillion spent annually in the health care industry, according to the U.S. Government Accountability Office.
Not so fast.....so much more to KNOW! James K Happ....(Smoking GUN)
Banks Are Uniquely Positioned to Prevent Health Care Fraud
By Matt Squire
Bank compliance professionals are in a prime position to uncover health care fraud if they are aware of the tell-tale signs and report the related suspicious activity to law enforcement, say fraud investigators.
Health care fraud accounts for around 10 percent or $100 billion of the $1 trillion spent annually in the health care industry, according to the U.S. Government Accountability Office.
Healthfirst largest health plan for Medicaid beneficiaries pay $35 million FRAUD
Health plan settles fraud charges with state
A related indictment accuses a former Healthfirst executive of concealing a practice of paying employees based on productivity, which is prohibited to protect consumers from aggressive sales tactics.
Healthfirst, New York state’s largest health plan for Medicaid beneficiaries, agreed to pay $35 million to settle charges by the attorney general that it had submitted false marketing plans.
A former senior executive of Healthfirst was also indicted earlier this year on related charges, the attorney general’s office said.
Last November, the state Department of Health temporarily shut down enrollment in all but Healthfirst’s Medicare plans after the attorney general’s investigation was revealed. The company, which has about $1 billion in annual premium revenues, provides coverage for about 500,000 people in New York and New Jersey.
In the wake of the shutdown, which ended in March, Healthfirst’s chief executive and founder, Paul Dickstein, and chief operating officer James Boothe stepped down.
It was Mr. Boothe who was indicted in May for first degree insurance fraud, a felony.
The indictment alleges that Mr. Boothe caused Healthfirst to submit false marketing plans to the state and to local government agencies, and concealed the information that Healthfirst paid its marketing representatives based on their productivity, which is prohibited. According to the indictment, the payment plan violated the company’s contract with the state from 1999 through 2003. Healthfirst management reported the violations to the state, and the company cooperated with the attorney general’s investigation.
The rules governing the marketing of Medicaid plans are designed to protect people from aggressive sales tactics.
In January, Patricia Wang, then a senior vice president at Greater New York Hospital Association, was named Mr. Dickstein’s successor.
“None of the conduct involved relates to current practices of Healthfirst, and the company is in complete compliance with all relevant regulatory requirements,” said a spokesman for Healthfirst, whose owners include Beth Israel Medical Center, Mount Sinai Medical Center and The New York City Health and Hospitals Corp.
A related indictment accuses a former Healthfirst executive of concealing a practice of paying employees based on productivity, which is prohibited to protect consumers from aggressive sales tactics.
Healthfirst, New York state’s largest health plan for Medicaid beneficiaries, agreed to pay $35 million to settle charges by the attorney general that it had submitted false marketing plans.
A former senior executive of Healthfirst was also indicted earlier this year on related charges, the attorney general’s office said.
Last November, the state Department of Health temporarily shut down enrollment in all but Healthfirst’s Medicare plans after the attorney general’s investigation was revealed. The company, which has about $1 billion in annual premium revenues, provides coverage for about 500,000 people in New York and New Jersey.
In the wake of the shutdown, which ended in March, Healthfirst’s chief executive and founder, Paul Dickstein, and chief operating officer James Boothe stepped down.
It was Mr. Boothe who was indicted in May for first degree insurance fraud, a felony.
The indictment alleges that Mr. Boothe caused Healthfirst to submit false marketing plans to the state and to local government agencies, and concealed the information that Healthfirst paid its marketing representatives based on their productivity, which is prohibited. According to the indictment, the payment plan violated the company’s contract with the state from 1999 through 2003. Healthfirst management reported the violations to the state, and the company cooperated with the attorney general’s investigation.
The rules governing the marketing of Medicaid plans are designed to protect people from aggressive sales tactics.
In January, Patricia Wang, then a senior vice president at Greater New York Hospital Association, was named Mr. Dickstein’s successor.
“None of the conduct involved relates to current practices of Healthfirst, and the company is in complete compliance with all relevant regulatory requirements,” said a spokesman for Healthfirst, whose owners include Beth Israel Medical Center, Mount Sinai Medical Center and The New York City Health and Hospitals Corp.
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