Leveraging the Nurse Practitioner

Mid-level providers like nurse practitioners (NP) are being utilized more and more. According to a report from the nation’s leading provider search firm Merritt Hawkins, “the NP workforce in the US has grown rapidly in recent years. Today, the number of NPs completing their training programs each year exceeds the number of medical residents in […]

Common Vehicle for Kickbacks – Marketing Companies and MSOs

There’s no shortage of kickback cases, especially in the lab, DME, and telemedicine space. I review the DOJ announcements almost daily, and the common story is that kickbacks are being funneled through MSOs and “marketing companies.”  A good example is this case [https://www.justice.gov/usao-wdpa/pr/florida-businessman-pleads-guilty-three-cases-involving-conspiracies-commit-health-care], where a bad actor entered into “sham contracts with marketers.” HVG receives […]

An FMV Opinion is Worthless…

An expert’s FMV opinion is worthless without sufficient, relevant, unbiased market data or evidence to support the opinion. A subject matter expert must have a basis for their opinion, such as facts, survey results, benchmarks, research, transaction multiples, etc. Sufficient data might include: 1.   Survey sample size of 50 or more entries 2.   10 or more transaction […]

Chronic Care Management – Industry Snapshot

According to the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), chronic diseases are conditions that last 1 year or more and require ongoing medical attention. Chronic diseases such as heart disease, cancer, and diabetes are the leading causes of death and disability in the United States and are also leading drivers of […]

EKRA Defense Not Holding Water

On September 2nd, the DOJ reported that Mark Schena, president of Arrayit Corporation, a biomedical company was convicted of orchestrating a $77 million scheme involving mainly false and fraudulent claims for Covid-19 and allergy testing.  Mr. Schena also paid kickbacks and bribes to recruiters and doctors to run allergy testing. [https://www.justice.gov/opa/pr/medical-technology-company-president-convicted-77-million-covid-19-and-allergy-testing-scheme] One of the failed […]

Specimen Collection Fraud is Ripe for Enforcement

The US Attorney recently announced charges against 47 defendants in a $250 million fraud scheme, claiming to be the largest pandemic-related case to date. [https://www.justice.gov/opa/pr/us-attorney-announces-federal-charges-against-47-defendants-250-million-feeding-our-future] This underscores the DOJ’s commitment to fight COVID-19-related fraud. One area that is ripe for enforcement is the laboratory space and their arrangements with specimen collection sites.  It’s possible that […]

Kickbacks Are Not Always Cash

In the case of sleep and respiratory DME manufacturer Respironics, the Company helped one of its suppliers secure an interest-free loan that was fully guaranteed by Respironics. Under terms of the loan, Respironics bore the full financial risk of non-payment.  It’s important to remember that “value” can come in forms other than cash.  Value can be conveyed […]

Don’t Dismiss Commercial Reasonableness 

In a recent a case, a home health owner pleaded guilty to paying kickbacks and billing for services that were never provided or were not medically necessary (of course).  The kickbacks were paid through sham employment agreements/relationships.  I believe a more scrutinous look at the necessity of those employment arrangements would have revealed something inappropriate […]