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Physicians Beware! Groups Providing DME, Prosthetic Devices, and Other Medical Supplies to Their Medicare Patients Risk Violating the Strict Liability Stark Law Since the Expiration of COVID-19 Public Health Emergency

Health Law Advisor

2] This means, in most cases, that Medicare beneficiaries must now come to a physician practice’s office location to pick up their DME – including IUCs – when the DME items are furnished and billed by physicians or their practices. The IOAS exception does NOT apply.

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FBI, DOJ bust 24 people in $1.2 billion telemedicine fraud scheme

Healthcare IT News - Telehealth

The illegal kickback scheme allegedly involved companies that received money in exchange for referral of Medicare beneficiaries by medical professionals for back, shoulder, wrist and knee braces that are medically unnecessary. WHY IT MATTERS. billion in losses. ON THE RECORD. WHAT ELSE TO KNOW.

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Federal Jury Convicts New York Doctor of Healthcare Fraud Scheme

Med-Net Compliance

A federal jury convicted a New York ENT doctor for defrauding Medicare and Medicaid by causing the submission of false and fraudulent claims for surgical procedures that were not performed. Specifically, between January 2014 and February 2018, the doctor billed Medicare and Medicaid approximately $585,000 and was paid approximately $191,000.

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Florida Woman Lands Herself 6.5 Years in Prison, Owes $45 Million for Medicare Fraud Scheme

Pharmacy Law Blog

On November 22, 2017, a Florida woman who was accused of a $45 million Medicare fraud, received a six-and-a-half-year prison sentence, following a 2016 U.S. Supreme Court decision in her case holding that the government could not freeze untainted assets. Indest III, J.D., Board Certified by The Florida Bar in Health Law.

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SafeCo No More: The Changing Landscape of Scienter under the False Claims Act

Health Law RX

2] Companies that regularly submit claims to the federal government are familiar with the complex maze of rules and regulations that often govern them. 6] These government payor programs limit the amount pharmacies can charge for generic medications to the “usual and customary” price. [7] per 30-day supply). [9] June 1, 2023).

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Seventh Circuit Clarifies “Authoritative Guidance” for the False Claims Act

Hall Render

Turning to the present case, in Safeway , the relator alleged that the defendant engaged in the submission of false claims to the government when it “reported its ‘retail’ price for certain drugs as its ‘usual and customary’ price.” SuperValu Inc., of America v. Burr was applicable to lawsuits brought under the False Claims Act.

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How to Increase Your Health Plan’s CMS Star Ratings to Earn More Revenue In 2021

Innovaare Compliance

Annually, the Centers for Medicare & Medicaid Services (CMS) releases star ratings, which measure the quality of care health plans deliver for its members. Launched in 2007, star ratings enable the CMS as well as consumers to compare health plans on metrics other than cost. The CMS star ratings challenge.