Posts Tagged ‘kickbacks’

Is the Anti-kickback Exemption for Nephrologist going away?

Thursday, February 13, 2014 | By arlene | No Comments

The Anti-kickback Law was put in place to prevent Doctors profiting from referral or care of patients to any medical business they have any interest or relationship whereby they profit from that referral in any way. This covers all doctors, with the exception of Nephrologists, who are exempt; this has allowed them to profit from referrals to Dialysis clinics they are in partnership with. Where else can a Doctor refer his own patient to a clinic he is affiliated with and receive a very large sum right up front.

It’s possible that change may be in the works; once this exemption is no longer in place patients will have more freedom to change doctors and clinics as needed by their personal situation. At present Nephrologists are loath to trade or take another’s patient due to the present exemption and loss of the income from these allowed kickbacks.

DaVita sets aside more contingency funds

Monday, November 11, 2013 | By Scott | No Comments

The Denver Post – 11/05/2013

Dialysis giant DaVita HealthCare Partners has set aside an additional $97 million on top of $300 million the company put in a contingency fund this year to settle criminal and civil anti-kickback investigations.

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Fraudulent Ambulance Billing To Medicare

Tuesday, October 29, 2013 | By Scott | No Comments

Here is a brief description of the type of ambulance fraud we have been seeing.

Medicare will pay for emergency and non-emergency ambulance services only when a beneficiary’s medical condition at the time of transport is such that other means of transportation, such as taxi, private car, wheelchair van or other type of vehicle is contraindicated (i.e. would endanger the beneficiary’s medical condition).  Medicare does not cover any means of transport other than transport by ambulance.

Non-emergency transportation by ambulance is appropriate and covered only when a patient is bed-confined and his/her condition is such that transportation by ambulance is medically required.  Medicare defines bed confinement as: unable to get up from bed without assistance; unable to ambulate;  and, be unable to sit in a chair or wheelchair.

Much of the income for many ambulance companies is generated by providing non-emergency ambulance transport to Medicare recipients to medical centers, such as dialysis clinics.

The companies transport patients who could walk or be transported by other means (i.e., taxi or paratransit van), falsely representing to Medicare that these patients medically required transportation by ambulance.  For example, patients are directed to get onto a stretcher or were placed onto a stretcher by ambulance company employees, when the patients were able to walk or to be moved by wheelchair.  Alternatively, some patients simply walk to and from the ambulance.  This also permits the ambulance company to transport 2-5 patients at once in the ambulance, rather than just one patient on a stretcher. 

The ambulance company then bills Medicare for the transport of these patients by ambulance, claiming it was a medical necessity.  The majority of dialysis patients need to attend dialysis treatments three times per week, thereby allowing the ambulance company to bill extensively for these patients.  For a round-trip transport, Medicare can pay between $400-800 per person depending on the area of the country and the patient’s needs. 

Kickbacks may be involved in this process:

  1. KBs from ambulance company to dialysis clinic employees who recruit, solicit or identify potential patients for the ambulance company.  Dialysis clinic employees, esp. admissions staff, often see the patients walking, etc. from the ambulance and know which ones are complicit in the fraud.
  2. KBS to physicians who will sign a certificate claiming that a patient requires transport due to a medical necessity.
  3. KBs to the patients themselves who are supposed to receive ambulance transport and do not need it.  Patients are often paid “signing bonuses” for agreeing to be transported by an ambulance company, or from switching from one company to the next.  There is considerable competition between ambulance companies for these patients.

Damages from these cases can range from the six figures up to $5-10 million depending on the size of the company.

 

Controversial Kidney-Dialysis Law Upheld by Florida Court

Sunday, January 27, 2013 | By arlene | 1 Comment

It appears that Florida realizes the “Conflict of Interest” of dialysis centers sending patients to their very own labs, is not in the best interest of patients. I applaud them and more States and CMS (Medicare) should stand up to the self interest. The Anti-kickback and Stark Law were passed for every other Physician except Nephrologists.

Read the Courts decision!

AMIGEN PEADS GUILTY 172 MILLION SETTLEMENT

Friday, December 21, 2012 | By arlene | No Comments

Bill Ruehle Fights Back – Corporate Crime Reporter

For nine years, William Ruehle was the chief financial officer of Broadcom.

Then, in 2006, Ruehle and Broadcom got caught up in the options backdating scandal.

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The American biotech giant Amgen pled guilty illegally introducing a misbranded drug into interstate commerce.

The plea was part of a global settlement with the United States in which Amgen agreed to pay $762 million to resolve criminal and civil liability arising from its sale and promotion of certain drugs.

Amgen pled guilty to illegally introducing a misbranded drug, Aranesp, into interstate commerce.

Amgen was represented in the criminal case by David Rosenbloom of McDermott Will & Emery in Chicago.

Under the Food, Drug and Cosmetic Act, it is illegal for drug companies to introduce into the marketplace drugs that the company intends will be used “off-label” – for uses or at doses not approved by the FDA.

Aranesp is an erythropoiesis-stimulating agent (ESA) that was approved by the FDA at calibrated doses for particular patient populations suffering from anemia.

In order to increase sales of Aranesp and reap the resulting profits, Amgen illegally sold the drug with the intention that it be used at off-label doses that the FDA had specifically considered and rejected, and for an off-label treatment that the FDA had never approved. Continue reading “AMIGEN PEADS GUILTY 172 MILLION SETTLEMENT” »