June 15, 2020 News
Paycheck Protection Program Fraud
The federal government enacted the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) in March of 2020 to address the economic impacts of the COVID-19 pandemic. As part of the CARES Act, Congress authorized up to $349 billion dollars in forgivable loans to small businesses through the Paycheck Protection Program (PPP). Soon after its passage, Congress authorized an additional $300...Read MoreMay 27, 2020 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 MoreMay 11, 2020 News
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 MoreApril 17, 2020 News
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 MoreApril 8, 2020 News
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 MoreSeptember 17, 2019 News
“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 MoreAugust 23, 2019 News
“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 MoreJuly 3, 2018 News
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 MoreJune 29, 2018 News
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 MoreJune 8, 2018 News