by Charles Ornstein and Ryann Grochowski, ProPublica
As promised, the Centers for Medicare & Medicaid released an unprecedented trove of physician reimbursement data, opening up the agency’s practices to public review and scrutiny.
The data represents payments made to doctors, hospitals and clinics in 2012, including names, addresses, procedures and specific dollars amounts reimbursed for more than 880,000 healthcare providers, amounting to nearly $77.4 billion in payouts.
MASSDEVICE ON CALL — Healthcare and Justice Dept. regulators hit a new record high in recovered healthcare dollars, with $4.3 billion returned to federal health programs in 2013.
That’s a return of more than $8 for every $1 spent on federal Health Care Fraud and Abuse Control Programs, according to McClatchy DC.
New York-based Doshi Diagnostic Imaging Services and Diagnostic Imaging Group LLC agreed to pay $15.5 million to settle whistleblower allegations that they colluded to defraud Medicare and paid physicians for referrals.
California medical device maker EndoGastric Solutions agreed this month to pay $5.3 million plus interest to settle Justice Dept. allegations that the company engaged in Medicare fraud and illegal kickbacks to promote its EsophyX acid reflux disease treatment device.
MASSDEVICE ON CALL — Federal regulators last fiscal year secured $3.8 billion in settlements of whistleblower lawsuits, the 2nd-highest take in Justice Dept. history, surpassed only by the $5 billion recovered in 2012.
The vast majority of settlement dollars came from healthcare fraud cases, comprising about $2.6 billion, according to a DoJ report.
An accomplice in the largest Medicare fraud scheme in New Jersey history was sentenced yesterday to 8 months of house arrest and ordered to pony up nearly $590,000 in restitution, according to court documents.
A prominent New Jersey cardiologist was sentenced yesterday to 6½ years in prison and ordered to repay the $19 million in fraudulent reimbursements he reaped from a fraud scheme federal prosecutors called "the largest recorded in New Jersey, New York and Connecticut for an individual practitioner."
A Washington, D.C. judge this week denied a bid by cardiologist Dr. Ishtiaq Malik to fight a $17 million judgment over false Medicare claims.
U.S. District Judge Robert Wilkins denied out of hand Malik’s claim that the evidence failed to demonstrate that he "acted with reckless disregard." The court ruled that the argument wasn’t grounds for relief, as it had been brought up before.
MASSDEVICE ON CALL — Researchers say a "significant percent" of the $3.62 billion that the Centers for Medicare & Medicaid spent on orthotics and prosthetics between 2007-2011 went to unlicensed providers. Agency attempts to stem the fraud have only served to strangle legitimate providers in red tape, according to the American Orthotic Prosthetic Assn.
Billions of Medicare dollars went to "providers who Congress specifically intended to exclude from eligibility for payments," according to an AOPA report.