Tag Archives: Medicare

WSJ Fraud-Fighting Superhero vs. Physician Villains

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Adding to the feeding frenzy, the media is piling on and doing their own healthcare fraud investigations.  Over the last month, the WSJ and Russell Adams (russell.adams@wsj.com) have published a series of articles on physician fraud and abuse based on their thorough analysis of public records.  And, now Dow Jones, the publisher of the WSJ is suing the American Medical Association (AMA) for access to full Medicare records in an effort to further expose fraud:

“The Medicare system is funded by taxpayers, and yet taxpayers are blocked from seeing how their money is spent,” said Robert Thomson, editor-in-chief of The Wall Street Journal. “It is in the interest of law-abiding practitioners that those who are gaming the system are exposed. Unless funds are used efficiently and intelligently, the health of the nation, physically and fiscally, will be undermined.” (excerpted from this WSJ article) Continue reading

Pharma Exec Banned from Govt Business

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OIG/HHS announced today that the former Chairman and CEO of KV Pharmaceuticals, Marc Hermelin, has been banned from conducting business with the US Federal Government for 20 years.  He resigned his position on November 10th in an effort to prevent exclusion of KV from selling drugs/medicines that are reimbursed by Medicare, Medicaid, and Tricare.  HHS has been promising to pursue exclusion of executives, and we now have our first example in pharma. Continue reading

Is Too Much Compliance Good or Bad?

Author: Mary Holloway

Earlier this year FDA Commissioner Margaret Hamburg promised more misdemeanor prosecutions for individuals in the healthcare industry.

On October 20, 2010, in a continued show of resolve to hold individuals accountable, the Office of Inspector General of the Department of Health and Human Resources published new guidance on permissive exclusion of officers and managers in the drug and device industry following a company plea.  If an individual is excluded it would significantly limit their ability to work in the health care field.  Federal healthcare programs (Medicaid, Medicare, Veterans Administration TRICARE, etc) will not pay for any items or services from an excluded individual.  In addition, an excluded individual would be prohibited from being employed, in any capacity, to provide any items and services which are billed to a Federal health care program. Continue reading