HHS OIG: $5.9B recovered this year in health care fraud investigations | Kroger pays $225K to settle drug handling accusations | Ex-N.J. doctor accused of illegal opioid distribution, health care fraud
The HHS Office of Inspector General's semiannual report to Congress showed $5.9 billion has been recovered from fraud investigations during fiscal 2019, compared with $2.9 billion collected last year. HHS brought 809 criminal actions and almost 700 civil actions during 2019.
Kroger and Kroger Pharmacy agreed to a $225,000 settlement to resolve a civil suit involving at least 16 alleged violations of the Controlled Substances Act from May 2, 2015, to May 30, 2016. The deal clears up allegations that Kroger's Rio Hill pharmacy in Charlottesville, Va., improperly filled "office use only" prescriptions for Schedule II controlled substances and failed to protect against the diversion of prescription drugs, among other violations.
Morris Starkman, a former doctor from New Jersey, was arrested and charged with multiple counts of illegal drug distribution and health care claims and insurance fraud on allegations he prescribed almost 1.4 million doses of oxycodone, oxymorphone, fentanyl and other highly addictive opioids from Jan. 1, 2015, to Jan. 1, 2018. Authorities also accused Starkman of submitting over $50,000 worth of inflated claims to private insurers for medical exams and tests that were medically unnecessary or unprovided, and medical services he was either not licensed or certified to provide.
Timothy Forester, a suspended pharmacist and former owner of four pharmacies in Pittsburgh, was charged with health care fraud, obtaining a controlled substance by fraud and misbranding of drugs as part of a 12-count superseding indictment. According to the indictment, Forester conspired with others to perform health care fraud and deliberately obtained hydrocodone and oxycodone by deception, fraud and misrepresentation, among other offenses.
More than 70% of home health agency executives responding to a Definitive Healthcare survey said they expect to expand their specialized services, primarily in palliative, veterans' and mental health care. More than 60% cited staffing issues as a barrier to expansion, and about 84% said they expect to use remote patient monitoring in the next two years, more than 70% plan to use medication management technology, and more than 60% expect to use mobile applications for concierge services.
The radiology department at Philadelphia-based Einstein Healthcare Network improved its clinical accuracy and efficiency by leveraging artificial intelligence tools and platforms, which allowed them to change the worklist priority notification for chest X-rays. The reprioritization allowed the radiology team to address acute findings much faster, and the findings are automatically entered into the report, which helped reduce radiologist burnout.
April 21-23, 2020, in Tampa, Fla. NHCAA's Boot Camp is a three-day training program that anchors the path to becoming an AHFI® and shows participants the skills necessary to become a leader within any health care anti-fraud organization. Designed for career switchers, inter-departmental transfers or new college graduates with less than three years of experience in health care fraud, this program will help your newest team members acquire an understanding of the core competencies necessary to combat health care anti-fraud. Learn more.