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Health Law Alert
2012: Issue 7
Why EMTALA is Worth Another Look: Enforcement on the Rise
By: Sarah E. Swank
In this economic downturn, the number of uninsured patients is on the rise. The impact on hospital emergency departments, where uninsured patients often seek treatment for a medical condition, is almost assured. The result: an increase in anti-dumping enforcement for hospitals. With the increased number of uninsured and poor entering hospital emergency rooms as a means of obtaining health care services, EMTALA compliance is worth another look.
Click to continue...Walgreens Settles Gift Card False Claims Act Allegations
The United States Department of Justice announced recently that Walgreens had agreed to settle federal False Claims Act allegations arising out of a prescription gift card program. The $9.2 million settlement concluded an investigation that alleged Walgreens had given gift cards to Medicare, Medicaid, Tricare and other federal health care program beneficiaries in exchange for transferring their prescriptions to Walgreens from their existing pharmacy. Although the company's advertising expressly prohibited such beneficiaries from receiving the gift cards, the government alleged that the gift cards were given to the beneficiaries regardless. The allegations were brought to the government's attention by two qui tam relators, one who learned of the gift card program as an independent pharmacist in Florida and the other as a pharmacy technician in Michigan; both filed federal and state False Claims Act lawsuits against Walgreens.
Click to continue...Massive Criminal Takedown Is Latest Salvo in Government's Intensified Campaign Against Health Care Fraud and Abuse
By: John S. Linehan
On May 2, 2012, the Justice Department and the U.S. Department of Health and Human Services (HHS) announced a nationwide takedown of 107 individuals for Medicare fraud schemes involving approximately $452 million in false billings. The wave of indictments were the culmination of the Medicare Fraud Strike Force's investigation of illegal schemes orchestrated by various health care workers, including doctors, nurses, and social workers in Baton Rouge, Chicago, Detroit, Houston, Los Angeles, Miami, and Tampa. Fifty-nine of the defendants were indicted in Miami for their involvement in a scheme to defraud Medicare of $137 million in false billings for home health care, mental health, and other services. Seven individuals were accused of submitting $225 million in false claims through two community mental health centers located in Baton Rouge—the largest-ever prosecution involving such institutions. The accused face a range of criminal charges, including health care fraud, conspiracy to defraud the Medicare program, money laundering, and violations of the antikickback statute. In addition, administrative action was taken against 52 providers pursuant to authority recently afforded by the Affordable Care Act that permits HHS to suspend payments until the completion of an investigation.
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