2015

December 14, 2015 Hot Topics

FRAUD/ABUSE

Laboratory to Pay $8.5 Million in False Claims Settlement: Wisconsin companies Pharmasan Labs, Inc. and NeuroScience, Inc. have agreed to an $8.5 million settlement following allegations under the False Claims Act. Pharmasan allegedly submitted false claims to Medicare for laboratory services including those referred by non-physicians for almost five years. Pharmasan and NeuroScience are also to enter into a Corporate Integrity Agreement which will require them in part to implement a compliance program. For more information, visit http://www.justice.gov/usao-wdwi/pr/osceola-laboratory-agrees-pay-85-million-resolve-false-billing-case

Hot Topics – 11/30/2015

November 30, 2015 Hot Topics

FRAUD/ABUSE

Ohio Long-Term Care Facility to Pay $1 Million Following Death of Resident: Beachwood Pointe Care Center, an Ohio nursing home, is to pay a total of $1 million in punitive and compensatory damages following the death of a resident. The lawsuit filed against the facility alleged that staff was negligent and reckless in treating the resident and failed to notify her family and physician of her poor condition. For more information, visit http://www.mcknights.com/news/nursing-home-to-pay-1-million-for-residents-death/article/453359/

Hot Topics – 11/04/2015

November 4, 2015 Hot Topics

FRAUD/ABUSE

South Carolina Hospital To Pay $237 Million to Resolve False Claims Act Violations: Tuomey Healthcare System, a SC hospital, is to pay $237 million for violations of the False Claims Act and Stark Law. In May 2013, a jury found that Tuomey violated the Stark Law by illegally billing Medicare for services referred by physicians with whom the hospital had an improper financial relationship. According to the U.S. Department of Justice news release, “Tuomey, fearing that it could lose lucrative outpatient procedure referrals to a new freestanding surgery center, entered into contracts with 19 specialist physicians that required the physicians to refer their outpatient procedures to Tuomey and, in exchange, paid them compensation that far exceeded fair market value.” According to the news release, the government also argues that Tuomey ignored and suppressed warnings from one of its attorneys that the physician contracts were “risky” and raised “red flags.” Under the settlement, Tuomey is to enter into a five year Corporate Integrity Agreement which will require any physician arrangements to be reviewed by an independent organization. For more information, visit http://www.justice.gov/opa/pr/united-states-resolves-237-million-false-claims-act-judgment-against-south-carolina-hospital

Hot Topics – 10/19/2015

October 19, 2015 Hot Topics

FRAUD/ABUSE

Long-Term Care Pharmacy Agrees to Settlement: PharMerica Corp., a long-term care pharmacy, has agreed to a $9.25 million settlement following allegations that it received kickbacks from a pharmaceutical manufacturer in exchange for the promotion of one of their drugs. The settlement is a result of a 2007 whistleblower lawsuit. The $9.25 million will be split between the federal government and Medicare. For more information, visit http://www.mcknights.com/news/pharmerica-agrees-to-925-million-settlement/article/443733/?DCMP=EMC-MCK_Weekly&spMailingID=12624302&spUserID=MTM2NDA4NTY3MTQ4S0&spJobID=640565786&spReportId=NjQwNTY1Nzg2S0

Hot Topics – 10/03/2015

October 3, 2015 Hot Topics

FRAUD/ABUSE

$118.7 Million False Claims Settlement Reached: A Florida-based healthcare company that operates nursing homes and hospitals in Florida, North Carolina, Tennessee, and Texas agreed to pay $118.7 million to settle False Claims allegations. The whistleblower lawsuit alleged that the company paid kickbacks, in the form of bonuses and increased salaries, to doctors in exchange for referrals. The settlement will be split among the federal government, the states of Florida, North Carolina, Tennessee, Texas, and the whistleblowers involved. For more information, visit http://www.mcknights.com/news/adventist-to-pay-118-million-to-settle-false-claims-suit/article/440139/

Hot Topics – 9/21/2015

September 21, 2015 Hot Topics

FRAUD

Bookkeeper Convicted of Stealing from Trust Fund Accounts of Patients: A bookkeeper at a nursing home in Birmingham, Alabama was convicted of first degree theft and computer tampering after stealing $4,068 from resident accounts. The bookkeeper allegedly tampered with electronic accounts by listing her co-conspirators as family members of the residents and writing checks to them, and has been ordered to pay full restitution. For more information, visit http://www.mcknights.com/news/nursing-home-bookkeeper-convicted-of-stealing-4000-from-resident-accounts/article/436544/

Hot Topics – 9/06/2015

September 16, 2015 Hot Topics

CMS

On August 13, 2015, CMS announced that 2,100 participants of its Bundled Payments for Care Improvement pilot program (BPCI) had moved to the contract, risk-bearing phase of the program. This phase includes 1,071 skilled nursing facilities and 101 home health agencies in addition to other participants. According to a July 12, 2015 article published in McKnight’s, bundled payments for hip and knee replacements in particular could threaten referrals to skilled nursing facilities with 1 or 2 star ratings. Under the bundled payment system, hospitals will be choosing their partners more carefully and making sure that they refer to “medically advanced facilities that can handle bundles with a high quality of care”. See http://www.mcknights.com/news/cms-announces-participants-in-bundled-payment-pilot-program/article/432911/ and http://www.mcknights.com/news/bundled-payments-for-hip-knee-replacements-would-put-pressure-on-snfs/article/425885/.

Hot Topics – 8/10/2015

August 10, 2015 Hot Topics

EMPLOYMENT

Workplace Violence Bill Proposed in MA: The Massachusetts Nurses Association has been pushing for a bill focusing on workplace violence prevention while citing statistics stating that healthcare workers, specifically female nurses, are at a high risk of violence by patients or their family members. While there is no federal requirement for such a law, many states independently require workplace violence programs. Requirements of the proposed MA bill include the development and implementation of workplace violence programs, annual risk assessments, and the creation of an in-house crisis response team. For more information, visit http://www.mcknights.com/news/state-bill-geared-toward-preventing-healthcare-workplace-violence/article/427949/

Hot Topics – 7/31/2015

July 31, 2015 Hot Topics

DISCRIMINATION (NON-EMPLOYMENT)

ADA Settlement: A Virginia nursing home has agreed to pay $97,500 to settle allegations that it violated the Americans with Disabilities Act. The complaint stems from a 2014 incident in which two deaf visitors claimed that the nursing home failed to provide them with aids to communicate with a family member who was a resident of the facility. Under the settlement, the nursing home is also required to train staff on relevant parts of the ADA. For more information, visit http://www.mcknights.com/news/nursing-facility-agrees-to-97500-disability-act-settlement/article/427696/

Hot Topics – 7/09/2015

July 9, 2015 Hot Topics

FRAUD/ABUSE

Settlement Reached Following Anti-Kickback and Stark Law Violations: The Westchester Medical Center (WMC) has agreed to a settlement in which they will pay $18.8 million and admit to illegal conduct in violation of the Anti-Kickback Statute and Stark Law. WMC was involved in a financial relationship with Cardiology Consultants of Westchester, P.C. (CCW) in which they provided money to CCW in exchange for referrals. Visit http://www.justice.gov/usao-sdny/pr/manhattan-us-attorney-settles-civil-fraud-claims-against-westchester-medical-center for more information.

Fraud

FRAUD/ABUSE

FRAUD/ABUSE

FRAUD/ABUSE

FRAUD/ABUSE

FRAUD

CMS

EMPLOYMENT

DISCRIMINATION (NON-EMPLOYMENT)

FRAUD/ABUSE