A Texas couple who owned and operated group homes recently was found guilty of perpetrating a $1 million dollar scheme to defraud Medicare. Lindell King, 52, and his wife Ynedra Diggs, 44 were charged with sending their group home residents to Behavioral Medicine of Houston (BMH), in exchange for kickbacks. BMH was a community mental health center that purportedly provided partial...
Currently, cBHRT is not on FDA’s list of difficult to compound products, falling under certain exemptions of the FD&C Act, particularly, Sections 503A and 503B. Under Section 503A, a human drug compounded for an identified individual patient based on a prescription qualifies for exemption from three sections of the FD&C Act: 1) current good manufacturing practice for drugs; 2) labeling of drugs...
Despite two years of COVID and a year’s worth of vaccinations, there remains some confusion over the privacy of an employee’s vaccination status. As a healthcare employer, are you permitted to ask your employees if they’re vaccinated? Do you breach the Health Information Protection and Accountability Act (HIPAA) in doing so? The quick answers to those questions are: it’s OK for an employer to...
From time to time, we run into risk adjusted conditions that are “newly discovered” by coders without fully applying the diagnostic criteria. Those conditions are then suggested to providers, who may not be up on the requirements for the condition and who may report them incorrectly. As we’ve blogged countless times before, the goal of risk adjusted payments is to correctly fund the care of...
Pharmacies and pharmacists continue to be a top enforcement priority for the U.S. Department of Justice and the myriad healthcare fraud task forces around the country. Recent Sentencing in Compounding Pharmacy Fraud Case Last month, a Mississippi pharmacist was sentenced to 5 years in prison for defrauding TRICARE (the government healthcare payer for the U.S. military and veterans) and some...
The U.S. Attorney arrested 13 people in a $100 Million healthcare fraud scheme in NY and NJ involving automobile insurance claims. Some of the facts alleged include— Bribed 911 operators and hospital employees for confidential information of insured drivers Unnecessary and painful medical procedures A non-physician owning medical clinics Paying hundreds of thousands of dollars to “runners” who...
