Category Archives: Fraud – Stark

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California Prosecutes 3 Doctors for Paying Patients to Submit to Unnecessary Surgery

The California Department of Insurance and the Orange County District Attorney’s Office have arrested three doctors in what they are describing  as the largest medical fraud prosecution in the nation. Some stories are so abhorrent  they taint entire professions. In Orange County, three physicians and a group of ambulatory surgery center developers, some of whom have already … Continue Reading

Employee Whistleblowers Cause $3 Million Dollar OverpaymentSettlement for Tennessee Cardiology Practice

Two former employees of East Tennessee Heart Consultants, a forty physician cardiology practice in Tennessee, tipped off federal prosecutors, who then filed a qui tam claim alleging the cardiology practice had a policy of retaining overpayments for services provided unless refunds were specifically requested, and that the practice maintained its billing records to conceal the … Continue Reading

OIG Reports Enforcement Actions

For those who doubt the possibility of OIG enforcement regarding fraud and abuse violations, the OIG Semi-Annual Report lists the following enforcement results: $2.8 billion on audit and investigative receivables; 3,806 individual and entity; receivables; 537 criminal actions; and 262 civil actions The report is accessible on the OIG Web site.… Continue Reading

Stark DHS Includes Nuclear Medicine

The final rule from the Medicare Physician Fee Schedule revises the Stark definition of designated health services (DHS) to include diagnostic and therapeutic nuclear medicine services. Since this change will impact existing relationships, this portion of the rule has a delayed effect date, i.e. January 1, 2007. Fee Schedule: Nuclear Medicine: DHS (CMS’s discussion on … Continue Reading

CMS Issues Stark Advisory Opinion

CMS Issues Stark Advisory Opinion Stating That Stock Interest In Non-Profit Practice Organization Is Not A Stark Financial Interest CMS has determined that stock held by physician shareholders in a 700 physician non-profit group medical practice does not constitute a financial interest for purposes of Stark, so that it would not prohibit referrals by the … Continue Reading
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