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  1. DOJ Charges Hundreds with $6B in Healthcare Fraud

    The Department of Justice (DOJ) charged 345 people across 51 federal districts in the largest healthcare fraud takedown in the agency’s history. The DOJ said the charges were in connection with cases responsible for more than $6 billion in losses. Among those charged were more than 100 doctors, nurses, and other medical professionals, according to the DOJ.

    The billions in false claims were submitted to both public and private insurers, the DOJ said, with more than $4.5 billion connected to telemedicine schemes. Alongside the fraud takedown, the Centers for Medicare & Medicaid Services (CMS) said it would revoke Medicare billing privileges from 256 medical professionals in connection with telemedicine fraud.

    Source:
    Fierce Healthcare [9/30/20]

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  2. Methodist Healthcare Accused of Paying Kickbacks to Oncologists

    Methodist Le Bonheur Healthcare (MLH), a non-profit healthcare system consisting of five hospitals as well as outpatient and ancillary services, has been accused of paying kickbacks in exchange for patient referrals. Between 2012 and 2018, over $400 million was allegedly paid by MLH for referrals from physicians at The West Clinic, a Memphis, Tennessee based, for-profit private physician group of medical oncologists, gynecologic oncologists, radiologists, and other physician specialists.

    The relators, a former MLH executive leadership team member and the former CEO for Methodist University Hospital, claim that MLH induced the referrals of cancer patients to their facility through kickback payments made to The West Clinic, in violation of numerous fraud and abuse laws.

    https://www.healthcapital.com/hcc/newsletter/10_20/HTML/METHODIST/convert_hc_topics_methodist_10.26.20.php

    Dr. David E. Marcinko MBA

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  3. US Healthcare Spending Waste is $1,800-$5,700 Per Person Per Year

    The American Journal of Public Health recently published an analysis of healthcare spending waste in the US by Arizona State University researchers. Here are some key findings:

    • Between $600 billion to more than $1.9 trillion of US healthcare spending is wasted every year.
    • Healthcare spending waste in the U.S. is between $1,800 and $5,700 per person, per year.
    • Reducing spending by 7% between now and 2030 would get the US to the levels of other countries.
    • Reducing spending by 3.3% annually until 2040 would get the US to the levels of other countries.

    Source: Arizona State University, November 17, 2020

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  4. HEALTH CARE FRAUD


    Dr. David E. Marcinko MBA

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