News

Natera: Company Using Incorrect Billing Codes to Inflate Insurance Cost, According to Billing Experts

Horizon 274, a genetic screening test by the company Natera (NTRA), provides prospective parents a simple way to forecast over 200 potential genetic conditions that they could pass on to their children. While the test relies on either a single blood draw or saliva swab, a Capitol Forum investigation finds that Natera is invoicing insurance companies for dozens of individual procedures covered...Read More

Enforcement Trends During Covid-19

Just as Covid-19 has interrupted businesses and imposed restrictions on industries throughout the economy, it is also having a major impact on healthcare enforcement actions brought by the DOJ and other agencies.  Even as regulations have loosened and social distancing restrictions have interrupted the progress of existing cases and slowed the rate at which new cases are being brought, other...Read More

Laboratory Advertising and Marketing After EKRA

The Eliminating Kickbacks in Recovery Act (the “EKRA”) has caused considerable consternation for laboratory industry participants and healthcare attorneys alike.  It represents a new, powerful enforcement tool for the federal government, and the extent of its reach and application have not yet been fully explored. One of the greatest areas of confusion is the effect that the EKRA will have on...Read More

Paid Leave Provisions Under the Families First Coronavirus Response Act: Exception for Employers of “Health Care Providers”

On March 18, 2020, President Trump signed into law the Families First Coronavirus Response Act (“FFCRA”), which became effective on April 1, 2020. Among other things, the FFCRA amends and expands the Family Medical Leave Act and also creates the Emergency Paid Sick Leave Act. The FFCRA establishes two new forms of paid leave that covered employers must provide to certain employees in response...Read More

“We Asked Prosecutors if Health Insurance Companies Care About Fraud. They laughed at Us.”

To protect their networks and bottom lines, health insurers don’t aggressively pursue widespread fraud, making it easy for scammers.  They they pass the costs off to you.   A look into private health insurance fraud and another contribution by Michael Elliott. https://www.propublica.org/article/we-asked-prosecutors-if-health-insurance-companies-care-about-fraud-they-laughed-at-us Read More

“Health insurers make it easy for scammers to steal millions. Who pays? You.”

Insurers are regarded as defenders of health care dollars, but the case of David Williams shows how they allow costs to rise.  Our own Michael Elliott is featured in this eye opening article by Marshall Allen about the rising costs of health care. https://www.vox.com/science-and-health/2019/7/19/20698355/health-insurance-scam-united-cigna-aetna-southwest   Read More

A history of bad blood: Theranos Inc. recently charged with conspiracy to commit wire fraud in the wake of related civil settlements

Elizabeth Holmes, founder and former CEO of Theranos Inc., and Ramesh “Sunny” Balwani, former president of Theranos Inc., have each been charged with conspiracy to commit wire fraud against investors, conspiracy to commit wire fraud against doctors and patients, and nine counts of wire fraud. If convicted, Holmes and Balwani each face a maximum sentence of twenty years in prison...Read More

Largest Fraud Enforcement Action in History

Attorney General Jeff Sessions and Department of Health and Human Services Secretary Alex M. Azar III announced today the largest health care fraud enforcement action in Department of Justice History. The takedown charged 601 individuals, across 58 federal districts for their alleged participation in health care fraud schemes involving more than $2 billion in false billings. Among the 601...Read More

Texas Medical Board Enforcement Process General Overview

  The Texas Medical Board’s Mission Statement is: “to protect and enhance the public’s health, safety, and welfare by establishing and maintaining standards of excellence used in regulating the practice of medicine and ensuring quality health care for the citizens of Texas through licensure, discipline, and education.” Every one of the 7,000 complaints the TMB...Read More

Michael Elliott Featured On WFAA Channel 8 Regarding Anti-Psychotic Medications

Our very own Michael Elliott was recently featured on WFAA Channel 8, discussing the controversial push for anti-psychotic medications by healthcare professionals:   “An off-label use of a drug is not illegal. What is inappropriate is for a drug company to market that drug for off-label uses.” See the full story here. Read More