Compliance News Roundup: $40 Million Bribe And Kickback Scheme Explained

1. Houston-Area Registered Nurse Pleads Guilty to Conspiring to Defraud Medicare of More than $5 Million: A Houston-Area registered nurse pleaded guilty today for his role in a Medicare fraud scheme that resulted in losses to Medicare of more than $5 million. Acting Assistant Attorney General Kenneth A. Blanco of the Justice Department’s Criminal Division, Acting U.S. Attorney Abe Martinez of the Southern District of Texas, Special Agent in Charge Perrye K. Turner of the FBI’s Houston Field Office, Special Agent in Charge C.J. Porter of the Department of Health and Human Services Office of the Inspector General’s (HHS-OIG) Dallas Regional Office, Special Agent in Charge D. Richard Goss of Internal Revenue Service Criminal Investigation’s (IRS-CI) Houston Field Office and the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU) made the announcement. Read more here: https://www.justice.gov/opa/pr/houston-area-registered-nurse-pleads-guilty-conspiring-defraud-medicare-more-5-million

2. U.S. investigates four insurers over Medicare payments - The U.S. Justice Department has disclosed an investigation into four health insurers after a lawsuit accused them of defrauding Medicare by claiming patients were treated for conditions they did not have or received no treatment for. The probe of Health Net Inc (MAHN.PK), Aetna Inc (AET.N), Cigna Corp's (CI.N) Bravo Health Inc and Humana Inc (HUM.N) was revealed in papers filed on Tuesday in federal court in Los Angeles, in a lawsuit the government recently joined against UnitedHealth Group Inc (UNH.N). The department last month partially intervened in the U.S. False Claims Act lawsuit brought by a former UnitedHealth executive, Benjamin Poehling, whose whistleblower case against the company and other insurers was filed under seal in 2011. Read more here: http://www.reuters.com/article/us-usa-health-lawsuit-idUSKBN16O2BQ

3. $40 million bribe and kickback scheme involving Forest Park Medical Center Dallas (FPMC) - You might remember that at the end of 2016, I posted about the unsealing of an indictment of 21 individuals allegedly involved in a $40 million bribe and kickback scheme involving Forest Park Medical Center Dallas (FPMC). The indictment alleged that FPMC paid approximately $40 million in bribes and kickbacks to surgeons, primary care physicians, chiropractors, lawyers, workers' compensation preauthorization specialists, and others in exchange for those individuals referring certain patients to FPMC. My parting comment on the post was “it’s going to be interesting to watch this case proceed over time.” And, it seems like the time is now. On March 17, 2017, one of the indicted physicians, Richard Ferdinand Toussaint, Jr., pleaded guilty to one count of conspiracy to pay healthcare bribes and kickbacks and one count of offering or paying illegal remuneration. To get the full scoop along with my commentary, check out this week’s deeper than the headlines blog post, $40 Million Bribe And Kickback Scheme Explained. http://www.healthicity.com/blog/deeper-than-the-headlines-40-million-bribe-kickback-scheme-explained

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