decisionhealth Newsletters, Part B News - 2019 Issue 2 (February)
Briefs: Physician owes $1 million for fraud and PA faces jail time for kickbacks
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Article Overview
This brief roundup summarizes several federal enforcement matters involving physicians and a physician assistant, including settlements, criminal exposure, and corporate integrity oversight. It is aimed at compliance, billing, and healthcare leadership readers who track fraud-and-abuse developments, Medicare-related allegations, and Department of Justice or HHS OIG actions.
Why This Topic Matters
These enforcement actions highlight the legal and compliance risks tied to medical necessity, referral relationships, manufacturer payments, and Medicare coverage issues. Readers can use the article to monitor fraud-and-abuse trends affecting physician practices and non-physician practitioners.
Article Sections
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Pain management doctor pays $1.7 million for drug screen, anesthesia fraud
Covers a settlement and related integrity obligations involving allegations in a pain management practice and associated ownership relationships. The section also notes broader federal fraud-and-abuse implications for the practice setting.
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Physician assistant faces jail time for accepting kickbacks
Summarizes a criminal case involving allegations of improper payments connected to prescription activity and manufacturer-sponsored programs. The section focuses on the enforcement context and sentencing exposure.
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The nerve: Neurosurgeon will pay nearly $81,000 to settle fraud allegations
Describes a Medicare-related settlement involving allegations about claim submission for diagnostic testing. The section references an HHS OIG enforcement announcement and related compliance concerns.
What You Will Learn
- How recent enforcement actions are being framed in physician and non-physician practitioner cases
- What types of compliance issues are drawing attention from federal agencies
- How settlements, criminal cases, and integrity agreements can arise from billing and referral allegations
- Why Medicare coverage and medical necessity remain central to fraud-related reviews
Who Should Read This
- Medical coders
- Billing compliance professionals
- Healthcare compliance officers
- Practice managers
- Physician group administrators
- Legal and audit staff
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