tci Medicare Compliance & Reimbursement - 2020 Issue Q4
Take a Look at 2 Recent Fraud Cases
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Article Overview
This article reviews two recent Department of Justice enforcement actions involving healthcare fraud, drug distribution, and anti-kickback allegations. It is relevant for compliance teams, healthcare administrators, billing professionals, and providers who want to understand the kinds of conduct that have drawn federal scrutiny and the roles of non-physician staff in these cases. The discussion focuses on general enforcement themes, the agencies involved, and the categories of wrongdoing referenced in the reported cases.
Why This Topic Matters
The article helps readers track current fraud enforcement trends and understand that investigations can extend beyond physicians to include staff, family members, and other participants in alleged schemes. That perspective is useful for compliance awareness, internal controls, and fraud-risk monitoring in healthcare settings.
Article Sections
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Medicare/Medicaid fraud and drug scheme
A summary of one enforcement action involving a physician-related drug distribution scheme and related healthcare fraud allegations. The section discusses the parties involved, the federal agency response, and the broader enforcement context.
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Genetic testing kickbacks
A summary of a second enforcement action involving alleged kickbacks tied to genetic testing for Medicare patients. The section describes the reported roles of the participants and the investigation’s focus.
What You Will Learn
- How recent federal enforcement actions are characterizing healthcare fraud risk
- Why non-physician staff and family members can be part of fraud investigations
- What broad categories of conduct are appearing in recent DOJ healthcare fraud cases
- How anti-kickback concerns can arise in genetic testing arrangements
Who Should Read This
- Compliance officers
- Healthcare administrators
- Medical practice managers
- Billing and coding professionals
- Physicians and advanced practice providers
- Healthcare legal and audit teams
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