Top Color:
Main Color:
Bottom Color:
Layout Style:
  • Wide
  • Boxed
HCCAnet Facebook Twitter LinkedIn Youtube Pinterest
You are here : Resources  >  View
Justice Department’s Criminal Division creates Appalachian Regional Prescription Opioid Strike Force - Living center that serves mentally disabled to pay $1.8M fine Doctor charged with prescription drug scheme - And More

Headlines

Justice Department’s Criminal Division creates Appalachian Regional Prescription Opioid Strike Force

Living center that serves mentally disabled to pay $1.8M fine

Doctor charged with prescription drug scheme

Allentown (PA) business owners have $3M consent judgment filed against them

Eye Centers of Florida pays $525K to settle Medicare billing fraud allegations

Philly firm and subsidiaries could pay $18+M to settle False Claims Act involving Medicare

Eastern KY medical equipment company to pay $5.25M for fraudulent claims

Feds charge former Pittsburgh health-care employees in multimillion-dollar Pa. Medicaid scheme

Government files False Claims Act complaint against Georgia ophthalmologist

St. Louis County doctor convicted for role in kickback scheme

Michigan home health agency owners get prison in Medicare fraud case

Regulatory News

CMS Update

From the OIG

In the Federal Register

CMS Transmittals

Acronym Library

Product Features

HIPAA Rules & Compliance

Investigative Interviewing

HCCA's Premium Newsletter: Report on Research Compliance | Subscribe Today >

 

 

Grow your healthcare compliance career | Join HCCA | Learn More >

 

 

Justice Department’s Criminal Division creates Appalachian Regional Prescription Opioid Strike Force

On October 25, 2018, Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division announced in a press release, “the formation of the Appalachian Regional Prescription Opioid Strike Force (ARPO Strike Force), a joint law enforcement effort that brings together the resources and expertise of the Health Care Fraud Unit in the Criminal Division’s Fraud Section (HCF Unit), the U.S. Attorney’s Offices for nine federal districts in five states, as well as law enforcement partners at the FBI, U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG) and U.S. Drug Enforcement Administration (DEA). The mission of the ARPO Strike Force is to identify and investigate health care fraud schemes in the Appalachian region and surrounding areas, and to effectively and efficiently prosecute medical professionals and others involved in the illegal prescription and distribution of opioids.”

 

Read More

 

 

Living center that serves mentally disabled to pay $1.8M fine

On October 24, 2018, The Pittsburgh Post-Gazette reported, “Passavant Memorial Homes and its pharmacy subsidiaries will pay $1.8 million to the U.S. government to settle claims that it dispensed drugs for legitimate medical needs but without valid prescriptions, the U.S. attorney's office said Wednesday.”

 

Read More

 

 

Doctor charged with prescription drug scheme

On October 24, 2018, The Detroit News reported, “A doctor who ran a cash-only clinic has been charged with conspiring to illegally distribute more than 1 million doses of drugs, especially opioids.

 

“Prosecutors say Dr. Afzal Beemath of Waterford appeared briefly in federal court Wednesday and was returned to jail to await another hearing on Thursday.”

 

Read More

 

 

Allentown (PA) business owners have $3M consent judgment filed against them

On October 24, 2018, WFMZ (PA) reported, “United States District Judge Jeffrey L. Schmehl has entered a $3 million consent judgment against Melchor Martinez, Melissa Chlebowski, both of Allentown, PA, and their businesses, as follows: Northeast Community Mental Health Centers (in Philadelphia); Lehigh Valley Community Mental Health Centers (in Allentown, Easton, and Bethlehem); and Carolina Community Mental Health Centers (in Raleigh, North Carolina).

 

“The consent judgment was entered on October 18, 2018 as part of a settlement resolving a civil health care fraud lawsuit filed by the U.S. Attorney’s Office for the Eastern District of Pennsylvania under the False Claims Act. The institutional defendants are community mental health clinics that were funded largely by Medicaid and Medicare.”

 

Read More

 

 

Eye Centers of Florida pays $525K to settle Medicare billing fraud allegations

On October 24, 2018, Becker’s ASC Review reported, “Eye Centers of Florida, based in Fort Myers, plans to settle Medicare billing fraud allegations with a $525,000 payment, according to the Naples Daily News.”

 

Read More

 

 

Philly firm and subsidiaries could pay $18+M to settle False Claims Act involving Medicare

On October 23, 2018, TAP into (PA) reported, “Philadelphia-based Vascular Access Centers L.P. and 23 subsidiaries will pay a minimum of $3.825 million to resolve claims that it violated the False Claims Act. The DOJ alleges Vascular Access Centers L.P., along with its 23 subsidiary and related corporations (collectively VAC), billed Medicare for non-reimbursable vascular access procedures performed on End Stage Renal Disease (ESRD) beneficiaries. Further the DOJ alleges that a kickback scheme related to referrals for such procedures also existed.”

 

Read More

 

 

Eastern KY medical equipment company to pay $5.25M for fraudulent claims

On October 22, 2018, WTVQ TV (KY) reported, “A Eastern Kentucky medical equipment supplier will have to pay more than $5 million for making false claims about the ingredients used in its medical creams.

 

“The United States Attorney’s Office for the Eastern District of Kentucky says Cooley Medical Equipment, Inc., headquartered in Prestonsburg, agreed to pay $5,254,912 to resolve the claims against it.”

 

Read More

 

 

Feds charge former Pittsburgh health-care employees in multimillion-dollar Pa. Medicaid scheme

On October 22, 2018, Pittsburgh Post-Gazette reported, “Four ex-employees of four related home health care companies have been charged in federal court with conspiring to rip off the Pennsylvania Medicaid program for millions of dollars.

 

“Travis Moriarty, 37, Tiffhany Covington, 41, Autumn Brown, 31, and Brenda Lowry Horton, 48, all of Pittsburgh, are charged in separate complaints, each with one count of conspiracy to commit health care fraud.”

 

Read More

 

 

Government files False Claims Act complaint against Georgia ophthalmologist

On October 20, 2018, AllOnGeorgia reported, “The government intervened and filed a complaint in a False Claims Act lawsuit against Aarti D. Pandya, M.D. a/k/a Arati D. Pandya, M.D., an ophthalmologist from Conyers, Georgia, and her practice Aarti D. Pandya, M.D., P.C. (the Pandya Defendants). The lawsuit alleges that the Pandya Defendants submitted false claims to Medicare for surgical procedures, diagnostic tests, and office visits that were medically unnecessary, of worthless value, upcoded, and in some cases, not provided at all.”

 

Read More

 

 

St. Louis County doctor convicted for role in kickback scheme

On October 19, 2018, KMOV (MO) reported, “A St. Louis County doctor has been convicted for his role in a kickback scheme involving a medical lab.

 

“Dr. Devon Golding, 72, was convicted on Friday for conspiracy to commit health care fraud four counts of substantive health care fraud.”

 

Read More

 

 

Michigan home health agency owners get prison in Medicare fraud case

On October 19, 2018, Associated Press reported, “Two Detroit-area home health agency owners have been sentenced to prison for their roles in what federal authorities describe as a multi-million dollar scheme to defraud Medicare.”

 

Read More

 

Managed Care Compliance Conference | January 27-30, 2019 | Lake Buena Vista, FL | Learn More >Managed Care Compliance Conference | January 27-30, 2019 | Lake Buena Vista, FL | Learn More >

 

CMS Update

 

Provider Compliance― Coding for Specimen Validity Testing Billed in Combination with Urine Drug Testing — Reminder

In a February 2018 report, the Office of the Inspector General (OIG) determined that Medicare payments to clinical laboratories and providers for specimen validity tests did not comply with Medicare billing requirements. A recent MLN Matters® Special Edition Article reminds laboratories and other providers about proper billing for specimen validity testing done in conjunction with drug testing; this article contains no policy changes.

Current coding for testing for drugs of abuse relies on a structure of presumptive and definitive testing that identifies the specific drug and quantity in the patient. This article includes descriptors for:

  • Presumptive drug testing codes
  • Definitive drug testing codes

Use the following resources to bill correctly and avoid overpayment recoveries:

 

 

 

 

In the Federal Register

Current Items

2018 FR Index

 

 

CMS Transmittals

View 2018 Transmittals

 

 

Acronym Library

Find CMS Acronyms

 

Product Features

 

HIPAA Rules and Compliance

 

Learn More

 

 

Investigative Interviewing

 

Learn More

 

Are you and your board compliance ready? | Get the knowledge and tools you need at the Board & Audit Committee Compliance Conference | Learn more >Are you and your board compliance ready? | Get the knowledge and tools you need at the Board & Audit Committee Compliance Conference | Learn more >

 

Become an HCCA Member!

Get discounts on events and products! Learn more about the benefits of an HCCA membership.

 

Want to share CWN with a friend?

To ensure they see the same great content you do, attach the CWN to an email instead of forwarding.

 

 

 

“My friend sent me CWN, and I like it!”

Do you want to receive the latest healthcare compliance news, too? Subscribe! It’s quick and free!

 

 

Questions/Feedback?

Please feel free to contact Margaret Dragon, editor of Compliance Weekly News.

print

View Results

Can't View the Full Content of this Resource?

To View the full content on this page you might have to login to your HCCA account. If you do not already have a login and password you can create one for free.

If you have a login click here

To create a free login click here

 
Health Care Compliance Library
HCCA offers members and registered guests access to an extensive library of articles. Information provided covers topics in corporate compliance and ethics in healthcare organizations. Contributing authors include attorneys, chief compliance officers, providers of auditing, monitoring, coding, billing and technology services, and other members of our compliance community.