Pharmacy board warns of fraudulent prescriptions for controlled substances The California State Board of Pharmacy recently warned pharmacies of an uptick in fraudulent California security prescription forms for controlled substances. The pharmacy board is encouraging pharmacies to take appropriate precautions to verify the legitimacy of prescriptions written by prescribers who have been identified as victims of this fraud. The pharmacy board maintains a list by county of prescribers who have reported stolen or fraudulent California security prescription forms. Pharmacies that receive prescriptions from a provider on this list have been advised to verify the prescription by contacting the provider's office using a phone number obtained from a source other that the prescription form itself. If you believe you are a victim of prescription fraud, see California Medical Association (CMA) On-Call document #3202,"Drug Prescribing: Unauthorized," which will walk you through the steps for reporting the incident to Federal and State agencies. On-Call documents are free to members in CMA's online health law library at www.cmanet.org/cma-on-call. Nonmembers can purchase On-Call documents for $2 per page. November 16, 2016 General Drug Prescribing, Fraud and Abuse 0 0 Comment Read More »
Educate office staff to avoid fraud and abuse In February 2015, the California Medical Association (CMA) issued a fraud alert to warn its members about clinical laboratory payments to referring physicians that may trigger fraud and abuse concerns. Some clinical labs have been offering physicians cash and gift incentives for blood draws of Medicare patients. CMA has continued to receive reports about these anti-kickback violations, which have led to several recent physician arrests in New Jersey, Virginia and other states. Furthermore, physicians' employees have also been implicated in these alleged bribes, including clerical staff and physician assistants. The Department of Justice forced settlements with Health Diagnostic Laboratory (Richmond, VA) and Singulex Inc. (Alameda, CA) that required payments of $47 million and $1.5 million, respectively. Because some of these labs are based in California, it would be a good idea for CMA members to educate their office staff on the different blood-specimen collection, processing and packaging arrangements that may be prohibited under federal anti-kickback statutes. The Office of the Inspector General at the Department of Health and Human Services has released guidelines for identifying potentially fraudulent schemes. CMA offers informational materials to help physicians understand these complex laws and the potential consequences of partnerships or agreements they enter into. Physicians with questions about specific arrangements should contact an attorney or their professional liability carrier to navigate the complexities of the anti-kickback and referral prohibitions applicable to their unique situation. To learn more about fraud and abuse laws, see the chapter titled "Fraud and Abuse: Referral Issues" in CMA's online health law library. The health law library is free to members in CMA's online resource library at www.cmanet.org/cma-on-call. Nonmembers can purchase documents for $2 per page. Contact: CMA Legal Information Line, (800) 786-4262 FREE or legalinfo@cmanet.org. July 6, 2015 General Fraud and Abuse 0 0 Comment Read More »
OIG issues fraud alert regarding physician compensation arrangements The Office of Inspector General (OIG) in the Department of Health and Human Services released a Fraud Alert in early June to caution physicians who may be engaged in fraudulent compensation arrangements. The anti-kickback statute prohibits arrangements that result in "improper remuneration" for physicians, such as accepting payment in exchange for referrals. The OIG Alert follows a recent settlement between the OIG and 12 physicians involved in "questionable" medical directorships and office staff arrangements with a chain of diagnostic centers in Texas. Physician compensation allegedly took into account the volume or value of referrals made to federal health care programs, rather than the fair market value of the rendered services. In select cases, the affiliated health care entity relieved physicians of paying the salaries of their office staff in exchange for referrals. Additionally, some of the 12 physicians are purported to have received payment for services they did not provide. Because the OIG found that these physicians are an integral part of the fraudulent scheme, they share liability under the Civil Monetary Penalties Law. The OIG stresses that both the physician and the institutions they are contracted with are held accountable for anti-kickback violations, even if only one purpose of the arrangement is to compensate physicians for referrals to federal health care programs. Any act of fraud involving federal health care programs may result in criminal, civil and administrative sanctions. Click here to read the OIG Fraud Alert. You may also learn more about physician relations in the OIG's "Compliance Program Guidance for Individual and Small Group Physician Practices" and "A Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud Abuse." For more information on the federal anti-kickback statute, see CMA On-Call document #1151, "Prohibitions Against Kickbacks and Fee-Splitting." This document, as well as the rest of the California Medical Association's online health law library, is available free to members in CMA's online resource library. Nonmembers can purchase documents for $2 per page. June 26, 2015 General U.S. Department of Health and Human Services, Fraud and Abuse 0 0 Comment Read More »
Fraud alert: recognizing relationships that may trigger fraud and abuse concerns for physicians The laws regarding fraud, abuse and anti-kickback violations can be complicated and difficult for physicians to navigate. However, it is increasingly important that physicians be aware of relevant prohibitions to avoid being implicated in a potentially fraudulent scheme. The California Medical Association (CMA) has received reports that some clinical laboratories, especially those testing for cardiovascular markers, are offering physicians cash incentives for blood draws of Medicare patients. Accepting such incentives could put physicians afoul of laws governing fraud and abuse. Anti-kickback laws prohibit physicians from offering or receiving anything of value in exchange for referral of patients. Although a number of safe-harbor provisions exist to limit the breadth of this prohibition, it is strictly enforced. Additionally, self-referral laws prohibit physicians from referring their patients for specified goods or services to entities in which the physician or a member of the physician's immediate family has a financial interest. Again, although exceptions do exist, the law presumes there is an ethical dilemma whenever a physician refers a patient to an entity in which he or she has a financial interest. CMA offers informational materials to help physicians understand these complex laws and the potential consequences of partnerships or agreements they enter into. Physicians with questions about specific arrangements should contact an attorney or their professional liability carrier to navigate the complexities of the anti-kickback and referral prohibitions applicable to their unique situation. To learn more about fraud and abuse laws, see the chapter titled "Fraud and Abuse: Referral Issues" in CMA's online health law library. The health law library is free to members in CMA's online resource library at www.cmanet.org/cma-on-call. Nonmembers can purchase documents for $2 per page. Contact: CMA Legal Information Line, (800) 786-4262 or legalinfo@cmanet.org. February 18, 2015 General Fraud and Abuse, Self-Referral, Clinical Laboratories 0 0 Comment Read More »
CMS announces new rules to curb Medicare fraud The Centers for Medicare and Medicaid Services (CMS) announced new rules will improve CMS’ ability to deny or revoke the enrollment of entities and individuals that pose a program integrity risk to Medicare. According to a press release, the “new safeguards are designed to prevent physicians and other providers with unpaid debt from re-entering Medicare and remove providers with patterns or practices of abusive billing." These changes are expected to save more than $327 million annually. CMS announced it has already removed nearly 25,000 providers from Medicare. Its strategy for curbing unscrupulous providers includes predictive analytics technology, fingerprint-based criminal background checks and temporarily freezing enrollment of new ambulances and home health providers in seven "fraud hot spots." "For years, some providers tried to game the system and dodge rules to get Medicare dollars; today, this final rule makes it much harder for bad actors that were removed from the program to come back in," said CMS Deputy Administrator and Director of the Center for Program Integrity, Shantanu Agrawal, M.D. For more information, see the CMS fact sheet on this rule. December 16, 2014 Medicare CMS, Fraud and Abuse, Medicare, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
CMS warns of fraudulent DME suppliers The Centers for Medicare and Medicaid Services (CMS) sent a letter this week to physicians asking them to pay attention to solicitations they receive from durable medical equipment (DME) suppliers and report any suspicious activity to the U.S. Department of Health and Human Services' Office of the Inspector General (OIG). According to CMS, most fraudulent solicitations are obvious in their wording or their attempts to get physicians to approve unnecessary medical equipment and supplies. These marketing schemes by DME suppliers can include: •Unsolicited orders for medical equipment or supplies, often with wording such as “We received a call from your patient Jane Doe who wants you to order…” and then lists multiple items on a pre-printed order •Advertisements that Medicare will provide you with payment for patient referrals •Pre-completed medical necessity forms with instructions to just “Sign and Date Here” Physicians are urged to: •Pay careful attention to orders that cross your desk asking for your signature. Review the patient’s medical record before signing an order. •View with a skeptical eye unsolicited orders for patients no longer in your practice or whom you have not seen in a long period of time. •Document in your patient’s medical record the medical justification for any DME ordered for your patient. You also may want to keep a record of the DME you’ve ordered for your patient, similar to (or part of) your patient’s medication list. Suspected abuse may be reported to the OIG at hhstips@oig.hhs.gov, (800) 447-8477 or via fax at (800) 223-2164. January 31, 2014 General Centers for Medicare and Medicaid Services, CMS, Fraud and Abuse, Quality of Care 0 0 Comment Read More »
