Articles Tagged with Healthcare Fraud

opioid fraudOn November 29, 2017 Charles J. Gartland, D.O., age 59 of Cochranville, PA was indicted by a federal grand jury on charges of opioid diversion and health care fraud.

United States Attorney David J. Freed said the charges of the indictment were handed down based on the belief that Gartland headed up a plan to defraud two health care benefit programs, Wellspan Health of York, PA and Medicare, by writing 221 prescriptions written in the names of three of his family members between the dates of September 2014 and August 2017.  The prescriptions were for the opiates Hydrocodone, Oxycodone, Fentanyl, Morphine and other controlled substances. The majority of the prescriptions were written for Hydrocodone-Ibuprofen.

The indictment notes that the prescriptions were not written for treatment of the family members but rather for the personal use of Dr. Gartland. Because of this, the prescriptions were not written in the realm of professional medical practice and were not used for a medical reason.

According to the Wall Street Journal, emails and other documents reviewed by the paper’s reporters reveal information uncovered by a tipster alleging that Glaxo’s China sales staff provided doctors with speaking fees, cash payments, lavish dinners and all expenses paid trips in return for prescribing the drug company’s products. Glaxo says it is looking into the matter. Like in the U.S., patients in China need a doctor’s prescription to buy regulated drugs and drug sales persons meet frequently with doctors to try to get them to prescribe products. However, unlike the U.S., the government controls all of China’s health care system so any purchased are through government paid physicians. Under the U.S. Foreign Corrupt Practices Act it is illegal for companies with significant U.S. operations to bribe foreign officials or their agents in exchange for business. Whistleblower tipsters are now coming forward to be part of the Securities and Exchange Commission’s new whistleblower program allowing the tipsters a reward of up to 30% of the moneys recovered. The Glaxo whistleblower says that between 2004 through 2010 Glaxo regularly gave cash to its sales staff in China and some of that went directly to doctors at Chinese hospitals in return for prescribing drugs from the company. Recently Glaxo settled a case with the U.S. Department of Justice relating to its drug marketing practices. Under the new SEC program, whistleblowers may come forward anonymously through counsel, thereby protecting themselves. Jeffrey Newman represents whistleblowers. jeffrey.newman1@gmail.com. www.JeffreyNewmanLaw.com

The Most Common Types of Healthcare Fraud and Abuse are:

1.Billing for treatments never performed: Healthcare providers will often bill for services that were never provided by either using a real patient’s healthcare information or through medical identity theft to create or embellish claims.

2. Upcoding: This is a type of healthcare fraud and abuse where they falsely bill for a service that costs more than the service that was actually provided. In addition to healthcare fraud and abuse, this practice impacts patients by falsifying their medical records which can hinder them from obtaining insurance due to a nonexistent previous condition.

This month the government unveiled a scheme by two companies Omnicare and IVAX, which was uncovered when whistleblowers came forward to file lawsuits.The settlements WHICH RESULTED IN OVER $112 million returned to the givernment are based on five separate whistle blower lawsuits filed by private individuals and consolidated in U.S. District Court in Massachusetts under state and federal false claims statutes. The states and the federal government alleged that Omnicare and IVAX engaged in several unlawful kickback schemes:

* Omnicare solicited and received $8 million for agreeing to purchase $50 million in generic drugs from IVAX Pharmaceuticals and to push nursing home patients to use the drugs.

* Omnicare paid $50 million to certain nursing home chains in exchange for 15-year contracts to refer nursing home patients to Omnicare for the patients’ drug purchases.