Jul 03 2018

Just Make Up Your Mind! – Success In Motion

Take a seat and listen in as Mark discusses the beauty of making a decision.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Jul 02 2018

Record Bust: 601 Defendants, Including 165 Doctors, Nurses and Other Licensees Charged With Over $2 Billion in Fraud

On Thursday, June 28th, the DOJ and HHS announced the largest ever health care fraud enforcement action. It resulted in charges against 601 defendants across 58 federal districts, including 165 doctors, nurses and other licensed medical professionals,  for their alleged participation in health care fraud schemes involving more than $2 billion in false billings.

The cases were coordinated by the Medicare Fraud Strike Force, a partnership between the DOJ’s Criminal Division, U.S. Attorney’s Offices, the FBI and HHS-OIG. Other federal and state agencies participated.

The prosecutions have a heavy opioid/dangerous narcotics focus: Of those charged, 162 defendants, including 76 doctors, were charged for their roles in prescribing and distributing those drugs.

Importantly, in addition to targeting schemes billing Medicare, Medicaid, and TRICARE, the feds also went after defendants who focused on billing private insurance companies for medically unnecessary prescription drugs and compounded medications that often were never even purchased and/or distributed to beneficiaries.

The defendants allegedly participated in schemes to submit claims for treatments that were medically unnecessary and often never provided. Patient recruiters, beneficiaries and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare.

The federal investigation was coordinated with a number of states’ Medicaid Fraud Control Units. As a result, in the states of Arizona, Arkansas, California, Connecticut, Delaware, Florida, Hawaii, Illinois, Indiana, Kansas, Louisiana, Maine, Michigan, Missouri, Mississippi, Nevada, New York, Oklahoma, Pennsylvania, Texas, Vermont, and Washington, 97 defendants were charged with defrauding the Medicaid program out of over $27 million.

From the many examples of alleged facts in the DOJ announcement:

  • An indictment in a compounding pharmacy fraud case alleges an attorney/marketer paid kickbacks and offered incentives such as prostitutes and expensive meals to two podiatrists in exchange for prescriptions written on pre-printed prescription pads, regardless of the medical need for the prescriptions. Once the prescriptions were filled, members of the conspiracy submitted approximately $250 million in fraudulent claims to federal, state, and private insurers for the compounded drugs.
  • In another case, defendants are a pharmacy chain owner, managing partner, and lead pharmacist charged with a drug and money laundering conspiracy. According to the indictment, the coconspirators used fraudulent prescriptions to fill bulk orders for over one million pills of hydrocodone and oxycodone, which the pharmacy, in turn, sold to drug couriers for millions of dollars.
  • A prosecution alleges a home health fraud and kickback conspiracy which resulted in more than $6.2 million paid by Medicare based on fraudulent billings.
  • A physician/owner of a pain management clinic was charged with unlawfully prescribing more than two million dosage units of Oxycodone.
  • Twelve defendants, including five medical professionals, were charged in various schemes involving health care fraud, unlawful distribution of controlled substances, aggravated identity theft, and money laundering. One of the schemes involved the operation of two false-front medical clinics.

The feds also announced that since this time last year, they excluded 2,700 individuals from participation in Medicare, Medicaid, and all other Federal health care programs, of whom 587 were excluded for opioid diversion and abuse. Over the past fiscal year, the DOJ has won or negotiated over $2 billion in judgments and settlements related to matters alleging health care fraud.

For those interested in the full press release, it can be found here. Additionally, documents (photos, links to indictments, and more) relating to the cases can be found here.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Jun 28 2018

What Does Partnership Really Mean? – Podcast

What does partnership mean in a medical group? What does it mean to you? What does it mean for your group? What does it mean if you are setting up a medical group?

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Mark F. Weiss

www.advisorylawgroup.com

Play

Jun 27 2018

Firefighters, Fear, and the Future of Your Medical Group – Medical Group Minute

The large red machine lumbered forward from behind, lights flashing. A fire engine heading off to a fire.
As horrible as a fire is — the danger involved, the risk of loss to the home or business owner — there’s also an inherent opportunity: an opportunity to rebuild, to renovate, and to renew. The stories of the phoenix or of Noah and the flood.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Jun 26 2018

What If Your Medical License Only Let You Treat One Patient or Work At One Facility? – Success In Motion

Ride along with Mark as he discusses a way to focus your mind on building your practice.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Jun 25 2018

FTC Challenge to Sanford Health/Mid Dakota Clinic Physician Group Merger and The Lesson For You

Like a bear emerging from its long winter nap, the Federal Trade Commission is hungry to enforce antitrust law in the healthcare sector, including, notably, in connection with monopolization through mergers in the market for physician services.

In 2017, the FTC challenged the proposed merger of physician group Mid Dakota Clinic into Sanford Health, an integrated healthcare system. 

The government alleged that the deal would violate antitrust law by significantly reducing competition, resulting in higher prices and lower quality of care for adult primary care physician services, pediatric services, obstetrics and gynecology services, and general surgery physician services in the greater Bismarck and Mandan metropolitan area. 

In December 2017, the FTC, acting together with North Dakota’s Attorney General, won a preliminary injunction in federal District Court blocking the merger. Sanford and Mid Dakota have appealed, and the case is currently winding its way through the appeal process.

Although the FTC has increased its scrutiny of physician group mergers, the merger of independent physician groups, that is, of groups not affiliated with hospital systems, continues to be an attractive alternative in the fight to build market share, especially in face of increasing competition from both integrated systems and national practice aggregators.

The lesson of increased scrutiny simply means that the parties to potential mergers must take antitrust law, both federal and state, into account at the earliest (that is, pre-planning) stages prior to any discussions with potential merger partners. What’s said and done even at the earliest stages of discussions can doom an otherwise pro-competitive arrangement.

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Mark F. Weiss

www.advisorylawgroup.com

Jun 21 2018

CVS, Aetna and Your Practice – Podcast

The Wall Street Journal portrays it as causing panic in the streets.

I’m taking about the pending acquisition of Aetna by CVS Healthcare. It’s stoking fear of the combination of a ubiquitous retail delivery platform, CVS, with the health insurance, managed care, and huge patient database of Aetna.

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Mark F. Weiss

www.advisorylawgroup.com

Play

Jun 20 2018

Blowing Up Your ASC Because Of Confusion Of Purpose – Medical Group Minute

Physicians (and others) considering forming a Medicare certified ASC have to be very careful about not confusing the ASC entity’s purpose.

If they do, they may not only blow the federal Anti-Kickback Statute (“AKS”) safe harbor on which they likely rely, they may destroy all of their Medicare claims by turning them into false claims.

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Mark F. Weiss

www.advisorylawgroup.com

Jun 19 2018

Crossing Over from Healthcare to Lifestyle Businesses – Success In Motion

Ride along as Mark discusses the flip side of the cosmetologist who opens a “medi-spa:” The expansion of medical practice beyond the traditional bounds of treatment into lifestyle.

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Mark F. Weiss

www.advisorylawgroup.com

Jun 18 2018

History Rhymes in Healthcare Just as it Does in Home Delivery Services: Ride the Trend

I read an interesting blog post about the fact that we tend to think we live in such modern times, when, in many cases, what we see as new is simply the repeat of a prior trend. The current instance may not be the same technologically, but, at its heart, it’s one and the same concept.

For example, we think that it’s very modern to have meals prepared remotely and then delivered to us at home. And, we think that it’s wonderful that now everything can be delivered to us via merchants such as Amazon or Jet.

But as that blog post pointed out, in the mid-1800s London, eating out was what people did. Even the relatively poor didn’t eat at home. That’s because it cost more to cook at home. Additionally, most people lived in apartments and most apartments didn’t have kitchens. Instead, apartments had a fireplace, which was sometimes used to heat a pot over some coals, but that required fuel (which was expensive) and it required time.

So, what developed was a culture in which even the poor ate at roadside stands, and in which even the working class could afford to have meals delivered: not only the food, but also the plates and utensils, just like home delivery catering today, but for the masses.

The same thing was true in mid-1800s London in terms of ride sharing. Most didn’t own carriages because they were very expensive. Instead there was a plethora of other ways to share rides – from horse-drawn buses and cabs to other shared coaches.

Londoners of the time also had shopping come to them. There weren’t any department stores, so vendors would travel from door to door, selling and delivering their specialties.

While history may not repeat itself, it’s been said that it sure does rhyme.

Trends (in one direction and then a reversal, and so on) are prevalent in healthcare, too.

As I describe in The Impending Death of Hospitals, healthcare was originally delivered in the home.

The notion of public hospitals didn’t exist in the U.S. until the mid-18th century when Dr. Charles Bond and Ben Franklin formed the first public hospital because the poor didn’t have homes in which to receive care.

The “hospital trend” is now reversing itself, with hospitals losing favor both in terms of their attractiveness to patients and payors. Instead, the care setting is trending toward surgery centers, other freestanding facilities, and even the home.

These trends ebb and flow like men’s ties move from wide to narrow.

Some few will be able to buck the trend. Some few will be able to devise a counter-trend as a way to distinguish themselves from other competitors.

But for most, the opportunity is to be found in riding the trend: How will you take advantage of the movement of care to sites outside of the hospital?

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com