Tags: CMS | healthcare fraud | RAC | White House

CMS and other federal agencies will expand use of payment recapture audits, currently used by recovery audit contractors, and thereby double the amount of recovered costs previously projected, according to a release by the White House. Read more...  

Tags: healthcare fraud | indictment | La Hacienda Family Clinic | mail fraud | Texas

Manuel Anthony Puig and his wife Romelia Sanchez Puig, both of Edinburg, Texas, were indicted by a federal grand jury for healthcare fraud, mail fraud and conspiracy to commit healthcare fraud, according to a news release from the U.S. Attorney's Office for the Southern District of Texas. Read more...  

Tags: Attorney General | Florida | legislation | Medicare fraud

A new bill proposed in the Florida legislature would give the state's attorney general power to investigate private managed care companies that administer Medicaid, according to a report in the South Florida Business Journal. Read more...  

Tags: Abdul Naushad | Advanced Pain Centers | Medicare fraud | Missouri | settlement | whistleblower suit

Abdul Naushad, MD, his wife, their six pain management clinics and their billing company have agreed to pay $820,000 to resolve civil Medicare fraud allegations, according to an announcement by the U.S. Attorney's Office for the Eastern District of Missouri. Read more...  

Tags: compliance | due diligence | healthcare | investment | private equity | transactions

The healthcare sector saw a significant decrease in the number of private equity transactions completed last year. Pitchbook (see: www.Pitchbook.com) reported that approximately 125 deals were completed where private equity funds invested in healthcare companies in 2009. This is down from 233 in 2008. This reduction takes into account both general economic conditions which saw declines in almost every sector, the overhang of healthcare reform where many investors saw tremendous uncertainty in the healthcare sector due to the potential for healthcare reform and the concern that some funds were over-invested in healthcare. Interestingly enough, much of the over-investing in healthcare resulted less because sponsors increased their percentage of investment in healthcare but more due to significant reductions in the values of the other investments which left their overall percentage of investment in healthcare higher both on the equity or debt side and thus over invested in healthcare. Read more...  

Tags: GOP | healthcare reform | President Obama

President Obama will consider adopting four proposals Congressional Republicans suggested in last week's healthcare summit on the president's health reform legislation, according to a letter the White House sent Republican and Democratic leaders in Congress. Read more...  

Tags: fraud | guilty plea | hospitals | medical equipment | Ohio

Robert E. Alick, the operator of a used medical equipment sales business and resident of Chagrin Falls, Ohio, pleaded guilty today to five counts of mail fraud, one count of wire fraud and one count of corruptly endeavoring to obstruct the administration of the Internal Revenue laws in a scheme to defraud six hospitals, according to a release from the Department of Justice and the IRS. Read more...  

Tags: antitrust | Congress | health insurance | Nancy Pelosi

In a rare showing of bipartisan agreement, the U.S. House voted 406-19 to repeal health plans' exemption from federal antitrust laws, according to a release from House Speaker Nancy Pelosi. Read more...  

Tags: Christiana Care Health System | Delaware | kickbacks | settlement

Christiana Care Health System in Wilmington, Del., has agreed to pay $3.3 million to settle claims made by a whistleblower that the health system allegedly paid kickback to neurologists for referring patients to its Wilmington hospital, according to a report in The News Journal. Read more...  

Tags: California | healthcare fraud | sentencing | Steven Kooshian

George Steven Kooshian, an AIDS physician based in La Quinta, Calif., was sentenced to 15 months in federal prison after pleading guilty to federal healthcare fraud charges for "subdosing" patients by administering doses of medicine that contained less than the prescribed amount of medication that the patients were supposed to receive, according to a news release from the Department of Justice. Read more...  

Tags: California | kickbacks | lawsuit | Prime Healthcare | Valley Health System

Testimony has ended in a trial over the proposed sale of Hemet, Calif.-based Valley Health System to Physicians for Healthy Hospitals, which alleges that the physician group influenced appraisers in their evaluation of the hospital district's assets, according to a report in The Press-Enterprise. Read more...  

Tags: healthcare reform | healthcare summit | Nancy Pelosi | President Obama

1. Its very unlikely that President Obama gained any Republican votes through his most recent healthcare summit and efforts on healthcare reform. President Obama's more than seven hour healthcare summit yesterday most likely did not win over any Republicans in support of any specific healthcare plan, including the draft legislation President Obama released on Monday. Read more...  

Tags: Brookhaven Memorial Hospital | inflated claims | Medicare | New York

Brookhaven Memorial Hospital Medical Center, on Long Island, N.Y., has agreed to pay $2.92 million plus interest to settle allegations that the hospital inflated charges to obtain supplemental outlier payments. Read more...  

Tags: embezzlement | guilty plea | Massachusetts

A practice assistant in the ENT Department at Beth Israel Deaconess Medical Center in Boston is pleading guilty to embezzling more than $1 million from the hospital, according to a release from the FBI.

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Tags: inflated claims | New York | NYSHIP | waiving out-of-pocket fees

Six healthcare providers in New York have reimbursed state officials more than $2.4 million in restitution and paid a combined $39,107 in fines for inflated billings submitted to the New York State Health Insurance Program, according to a report by Insurance & Financial Advisor.

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Tags: California | City of Angels Medical Center | kickbacks | sentencing

Robert Bourseau, the former owner of City of Angels Medical Center in Los Angeles, was sentenced to 37 months in federal prison for his role in a scheme to provide illegal kickbacks for the recruitment of homeless patients to come to the hospital for unnecessary treatments, according to a story in the Los Angeles Times.

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Tags: Connecticut | Johnson Memorial Hospital | Medicare | overbilling

Johnson Memorial Hospital in Stafford Springs, Conn., has agreed to pay $191,193 to resolve allegations that it improperly billed Medicare between 2000 and 2005, according to a report by the Hartford Courant.

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Tags: Eon Labs | Medicare | Nitroglycerin SR | Novartis AG | overbilling | Sandoz | settlement

Eon Labs, a subsidiary of Sandoz, which is in turn a subsidiary of Novartis AG, has agreed to pay $3.5 million to the federal government to resolve allegations that it submitted false claims to Medicaid involving the company's Nitroglycerin Sustained Release capsules, according to a Department of Justice news release.

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Tags: Cadillac Tax | health reform | health summit | premium increases | President Obama

President Obama has released his proposal for a health reform bill, which he will carry into a televised meeting on health reform with Democrat and Republican Congressional leaders on Thursday.

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Tags: malpractice | Michigan | Supreme Court

The members of the Michigan Supreme Court voted 4-3 in support of an order that would change the deadlines for healthcare providers being sued for malpractice, according to a report in the Chicago Tribune.

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