As drug prices rise in the U.S., some have expressed concerns that charitable payment of drug copays could be contributing to price inflation. This is because, although most patient assistance groups of this type are charities, pharmaceutical companies routinely donate to the groups.
Vascular Access Centers L.P., along with 23 subsidiaries and related corporations, has been accused of Medicare fraud, violating the False Claims Act, and violating the Anti-Kickback Statute and have agreed to pay at least $3,825 million to resolve the allegations. If certain contingencies arise, additional payments up to $18,360,794 could be triggered.
Medicare Advantage plans are owned and operated by private organizations called Medicare Advantage Organizations (MAOs). Medicare beneficiaries can enroll in and obtain healthcare through these plans. Unlike in traditional Medicare, MAOs are not paid based on services rendered but instead receive a fixed monthly amount for each beneficiary's care. Since some patients require more care than average, payments from Medicare to MAOs are "risk adjusted" to reflect the beneficiary's health status. In other words, MAOs receive higher payments for patients whose conditions require more care.
The federal government intervened in eight False Claims Act lawsuits and brought criminal charges against Health Management Associates, LLC (HMA), a hospital chain that has since been sold. According to the Justice Department, HMA engaged in a scheme to defraud the U.S. The allegations include:
It was an interesting scheme. According to allegations by the Department of Justice, Reliant Rehabilitation Holdings, Inc., wanted to induce or reward its client nursing homes for referring patients to Reliant for rehabilitation therapy. So, it sent over nurse practitioners employed by Reliant to work for those nursing homes for free or below market value.
A Texas doctor will receive $4.9 million as a reward for blowing the whistle on seven ambulance industry defendants who allegedly paid kickbacks to municipal entities in several states in exchange for lucrative ambulance business. The alleged kickbacks violated the federal Anti-Kickback Statute, which prohibits offering, paying, soliciting or receiving remuneration in order to induce referrals. The scheme allegedly resulted in false claims being submitted to Medicare and Medicaid, which violated the False Claims Act.
"When hospices increase their bottom lines by billing taxpayers for unneeded services, they are diverting money from vulnerable, terminally-ill individuals," said a spokesperson for the U.S. Department of Health and Human Services Office of the Inspector General. "Worse yet, these patients may not be receiving care for medical needs that would otherwise be covered in a non-hospice setting."
Livingston Regional Hospital, LLC, of Tennessee has agreed to settle a False Claims Act case brought against it in federal court. It will resolve the allegations for $784,000. The hospital is owned by LifePoint Health, Inc., which operates hospitals across the U.S.
A company called Healogics, Inc., has agreed to settle False Claims Act allegations for up to $22.51 million. The Florida company, which manages almost 700 hospital-based wound care centers nationwide, is accused of knowingly causing their wound care centers to falsely bill Medicare for hyperbaric oxygen ("HBO") therapy that was either unreasonable or medically unnecessary.
Skilled nursing facilities are in a position of trust. Especially when Medicare and Medicaid are involved, some nursing home patients are vulnerable. To protect them and the American taxpayer, their care should always be directed by their medical needs; never by the financial interests of the nursing home.