FRAUD/ABUSE

1.The Food and Drug Administration’s new policy proposal on repackaging drugs is being met with great opposition by the Long Term Care industry. The proposed policy puts new regulations on re-packaging time frames and where the packing takes place, creating a direct impact on the standard level of care required by Medicare and Medicaid. The CEO of the Senior Care Pharmacy Coalition submitted a detailed analysis and opposition letter to the FDA for consideration when drafting the final new policy provisions.

See following link: http://seniorcarepharmacies.org/wp-content/uploads/2015/12/SCPC-Letter-to-Jane-Axelrad-12-22-15.pdf

Read more…

FRAUD/ABUSE

FRAUD/ABUSE

Masoncare’s Wallingford nursing home has been named in a lawsuit filed by a former employee of third party vendor, Clinical Laboratory Partners (“CLP”), alleging that she was fired in retaliation for reporting a coworker who was videotaping residents and showing the videos to other employees. Interestingly, CLP was not named in the lawsuit even though Masonicare’s attorneys claim that all employees named in the lawsuit worked for CLP.

http://www.myrecordjournal.com/news/state/8904831-154/lawsuit-claims-retaliation-after-report-of-wallingford-nursing-home-residents.html

Read more…

FRAUD/ABUSE

FRAUD/ABUSE

Office of Inspector General recently reported to Congress on its success in protecting the integrity of the Health and Human Services Program initiative to prevent fraud, waste and abuse. HHS recovered an estimated $2.77 billion in fraudulent payments during the first half of the 2016 fiscal year. The OIG report lists fraud cases in the long-term care realm among its recovery highlights.

Please visit: http://www.mcknights.com/news/oig-healthcare-fraud-abuse-recoveries-up-1-billion-in-2016/article/500256/?DCMP=EMC-MCK_Daily&spMailingID=14634790&spUserID=MjQ0MjEyNTAxNzY3S0&spJobID=800077286&spReportId=ODAwMDc3Mjg2S0

Read more…

FRAUD/ABUSE

FRAUD/ABUSE

Employee of Ambulance Company Sentenced for Fraud: An employee of Pennsylvania ambulatory company was sentenced to 37 months in prison and 3 years supervised release, and is to pay over $2 million in restitution. The employee allegedly billed Medicare for services provided to patients who did not meet eligibility requirements. In total, Medicare reimbursed the company for more than $2 million in claims that were fraudulently submitted by the employee. For more information, visit

https://www.justice.gov/usao-edpa/pr/ambulance-company-employee-sentenced-37-months-prison

Read more…

FRAUD/ABUSE

FRAUD/ABUSE

The Department of Labor has issued a new manual/guide for interpretation of the Family and Medical Leave Act. The new reference includes a “roadmap” that walks the employer through the FMLA process from start to finish. A must read for all Human Resource Departments.

Please visit: https://www.dol.gov/whd/fmla/employeeguide.htm

Read more…

FRAUD/ABUSE

FRAUD/ABUSE

Owners of Physical Therapy Company Charged For Role in Fraud Scheme: The owners of a physical therapy company in Chicago have been charged for their alleged role in a $45 million fraud scheme. The allegations state that the owners were involved in a fraud scheme involving three home health care companies owned by one of the defendants’ mothers. These companies are accused of paying bribe and kickbacks in order to gain Medicare beneficiaries as well as falsifying medical records. For more information, visit

https://www.justice.gov/opa/pr/husband-and-wife-owners-chicago-physical-therapy-company-indicted-schemes-defraud-medicare

Read more…

FRAUD/ABUSE

FRAUD/ABUSE

Qui Tam Lawsuit Filed Against Medical Providers by Medical Society: The Florida Society of Anesthesiologists has filed a qui tam lawsuit against a group of physicians, anesthesiology companies, and ambulatory surgical centers claiming that they violated the federal and Florida False Claims Acts. The lawsuit alleges that the defendant ambulatory centers granted arrangements exclusively to several anesthesia companies owned by the defendant physicians in a kickback scheme. The US Attorney has decided not to get involved at this time, but the investigation remains ongoing.

Visit http://www.lexology.com/library/detail.aspx?g=fd0de139-4b22-42f1-b8e5-dd193c7b2fe4&utm_source=lexology+daily+newsfeed&utm_medium=html+email+-+body+-+general+section&utm_campaign=lexology+subscriber+daily+feed&utm_content=lexology+daily+newsfeed+2016-04-01&utm_term for more information.

Read more…

FRAUD/ABUSE

FRAUD/ABUSE

Ten Regional Nursing Home Task Forces to Be Created: The Department of Justice has announced that it will be launching ten regional nursing home task forces throughout the nation through their Elder Justice Initiative. The goal of these task forces is to investigate nursing homes that provide “grossly substandard” care to residents. They will be composed of a members from all levels of government including representatives from the US Attorney’s offices and state Adult Protective Services agencies. For more information, visit

http://www.mcknights.com/news/department-of-justice-launches-nursing-home-task-forces/article/486426/?DCMP=EMC-MCK_Weekly&spMailingID=14114215&spUserID=MTM2NDE0MDMyMDE5S0&spJobID=760052384&spReportId=NzYwMDUyMzg0S0

Read more…

FRAUD/ABUSE

DE Senator Questions HHS Regarding Inappropriate Social Media Posts by SNF Employees: Delaware Senator Tom Carper has spoken out to the Department of Health and Human Services about his concerns regarding the influx of unwelcome and inappropriate pictures and videos of residents posted on social media by nursing home workers. Carper asked HHS several questions about their plans to address such situations such as the number of HIPAA complaints that they have received thus far addressing these posts. For more information, visit  http://www.mcknights.com/news/senator-grills-hhs-over-nursing-home-workers-social-media-abuse/article/482193/?DCMP=EMC-MCK_Daily&spMailingID=13935193&spUserID=MTM2NDA4NTY3MTQ4S0&spJobID=740745283&spReportId=NzQwNzQ1MjgzS0

Read more…

FRAUD/ABUSE

Prison Sentence Handed Down in Scheme to Claiming to Reduce Falls: A chiropractor has been sentenced to approximately four years in prison and is to repay over $2.2 million for a scheme in which is sold orthotic boots to nursing home residents as a part of a so-called “Fall Prevention Program”. The Missouri man claimed that the boots would reduce falls by 20%, but the heavy boots were often found to be a cause of falls and ulcers in residents’ ankles. Each of the 600 pairs of boots sold over a five-year period cost Medicare between $2,400 and $2,600. For more information, visit

http://www.mcknights.com/news/chiropractor-sentenced-to-prison-in-snf-fall-reducing-boot-scheme/article/481005/?DCMP=EMC-MCK_Daily&spMailingID=13886384&spUserID=MTM2NDA4NTY3MTQ4S0&spJobID=740262139&spReportId=NzQwMjYyMTM5S0 and http://www.stltoday.com/news/local/crime-and-courts/st-louis-county-chiropractor-gets-years-for-health-care-fraud/article_ea414319-f3c5-556a-a8f3-8aed8c43f8ea.html

Read more…