Medicare Compliance & Reimbursement
HEALTH CARE EXECS BEWARE
Post-Enron hostility to corporate fraud takes its toll on a lab exec. William Thurston was originally sentenced by the trial court to three months in prison followed by supervised release for his role in a bundling scheme. But in United States v. Thurston (No. 02-1966 & 02-1967), the 1st U.S. Circuit Court of Appeals rejected the trial court's sentence and imposed the five-year statutory maximum. The case, which addresses claims submitted in the 1990s, involves the bundling of a rarely used blood test - a blood ferritin - into a popular blood test panel called a "LabScan." The ferritins were provided to physicians for free, or for a nominal cost, to keep them from complaining about the needless tests - but Damon, unbeknownst to the doctors, billed Medicare separately for the tests and generated millions in extra revenue. Thurston was convicted by a jury for his role in the case, but received a light sentence because of his charitable works, among other reasons. But charity wasn't enough to satisfy the 1st Circuit. "The ability to make large contributions should not keep a defendant out of jail," the appellate panel says. "Thurston's executive position at Damon, which gave him the resources to undertake many of his charitable works, also enabled him to perform the crime." The court argues that health care fraud is simply too serious not to come down hard on alleged perpetrators. "A five-year term of imprisonment in light of the nature of the crime reflects the seriousness of the offense, the need for congruity with 'blue collar' crime, and the need to deter other executives from similar law-breaking," the opinion says. The opinion is available at www.ca1.uscourts.gov/. Lesson Learned: With courts ready to dish out harsh sentences to health care executives, top-level buy-in to corporate compliance is more important than ever.
The growing disgust with corporate misdeeds hit a former vice president of Damon Clinical Testing Laboratories Inc. hard Aug. 4, as a federal appeals court saddled him with a five-year prison term in a blistering opinion.
Medicare Compliance & Reimbursement
- TENET FACES MORE SCRUTINY OF PHYSICIAN RELATIONSHIPS
This time, state fraud fighters in Florida are investigating the hospital chain.
Fraud fighters are paying [...] - MEDICARE PAY CUT LOOMING IN 2004
Only a few months after Congress turned a looming 4.4 percent Medicare pay cut into [...] - Dozens of Physician Procedures Slashed in 2004 Fee Schedule
99311, 45385, 99348 among hardest hit.
Physicians who see lots of patients in the nursing home [...] - ELECTRONIC CLAIMS EXCEPTIONS FEW AND FAR BETWEEN
Providers should get ready to go electronic with their Medicare claims.
When the Health Insurance Portability [...] - Top 4 Bases for Liability Under the False claims act
Learn these federal no-nos and prevent unwitting fraud.
When the government cracks down on False Claims [...] - EVERYONE DISLIKES AWP, BUTDOCS DISLIKE PROPOSED FIXES
Medicare beneficiaries and the government could save up to $45.2 billion over ten years if [...] - CMS SEEKS COMMENT ON FOUR PAYMENT SCHEMES
According to the Centers for Medicare & Medicaid Services, increasing practice expense reimbursements is irrevocably [...] - THREE-DAY INPATIENT STAY RULE VEXES SNFs, FEDS
The OIG thinks nursing homes are bungling hospital stay data
Skilled nursing facilities whose staffers don't [...] - Medicaid Probe Drives Supplier Out Of Business
DME suppliers should repeat this mantra: documentation, documentation, documentation.
A recent investigation focusing on three compliance [...] - HEALTH CARE EXECS BEWARE
Post-Enron hostility to corporate fraud takes its toll on a lab exec.
The growing disgust with [...] - FEDS SEEK INFO ON BRISTOL-MYERS COMPLIANCE REVIEW
Internal review covers sales, marketing and pricing practices.
As government scrutiny builds on pharma companies' sales [...] - ONLINE MEDICARE RESOURCES GET A LITTLE LESS COMPLICATED
CMS unsnarls a tangled web.
Confused by the sometimes-labyrinthine experience of navigating the Centers for Medicare [...] - M+C benes Spending More, But FFS Benes Spending even More
The average Medicare+Choice enrollee is spending about $1,964 out-of-pocket this year, 10 percent more than [...] - PROGRAM MEMO ROUNDUP
The interest rate for Medicare overpayments and underpayments went up August 11, rising from 11.625 [...]
