Compliance News Roundup: Conflicts of Interest

1. Former Administrative Law Judge Pleads Guilty for Role in $550 Million Social Security Disability Fraud Scheme: A former administrative law judge for the Social Security Administration (SSA) pleaded guilty in federal court today for his role in a scheme to fraudulently obtain more than $550 million in federal disability payments from the SSA for thousands of claimants. Read more here: https://go.usa.gov/xN4Y9

2. Acting U.S. Attorney Announces $54 Million Settlement Of Civil Fraud Lawsuit Against Benefits Management Company For Improper Authorization Of Medical Procedures: The HHS-OIG, announced today that the United States simultaneously filed and settled a civil fraud lawsuit against benefits management company CaRECORE NATIONAL LLC (“CARECORE”), now part of eviCore healthcare, for authorizing medical diagnostic procedures paid for with Medicare and Medicaid funds over a period of at least eight years without properly assessing whether the procedures were necessary or reasonable. The settlement, approved in Manhattan federal court by U.S. District Judge Richard J. Sullivan, resolves CARECORE’s civil liabilities to the United States under the federal False Claims Act. Under the settlement, CARECORE must pay a total of $54 million, of which $45 million will be paid to the United States and $9 million will be paid to the states that are named as plaintiffs in the suit. Read more here: https://www.justice.gov/usao-sdny/pr/acting-us-attorney-announces-54-million-settlement-civil-fraud-lawsuit-against-benefits

3. Deeper Than The Headlines: Conflicts of Interest - For those of you compliance folks who have struggled to have compliance conversations with physicians about COI (conflicts of interest), you might find some tips in one of the articles in JAMA.  And isn’t it nice that such a reputable medical journal has devoted such significant space to the topic? In this week’s Deeper Than the Headlines, I’ll use JAMA to explain how to improve your COI conversations with physicians. Read more here.