A federal jury found three former Outcome Health executives guilty of 47 counts of fraud. The convictions come after a 10-week trial that investigated the former leaders’ role in a billion-dollar scheme in which the company lied to its customers about how many physicians' offices their advertisements would appear in.
What's interesting in this special fraud alert and what was somewhat new is the dual emphasis on marketing and clinical decision making.
Munck Wilson Mandala Partner Greg Howison shared his perspective on some of the legal ramifications around AI, IP, connected devices and the data they generate, in response to emailed questions.
The charges involve some of the first cases in the country involving fraudulent cardiovascular genetic testing, a “burgeoning scheme,” according to a news release from the DOJ.
The California-based health system and insurer has bilked CMS out of "hundreds of millions of dollars" by submitting claims that were altered to make patients appear sicker than they were, a new complaint filed by the DOJ alleges. Kaiser denied these allegations saying it is confident in its compliance with Medicare Advantage program requirements.
A previous investigation by MedCity News found that ElectrifAi was touting an improperly-developed algorithm during the earliest phase of the Covid-19 pandemic, with both the company and CEO defendants in an employment discrimination lawsuit. A year later, lawsuits are piling up as more former employees complain that the company and CEO lied about its AI capabilities and business.
The California-based health system will pay a hefty price to resolve allegations that it knowingly submitted inflated diagnosis codes for certain Medicare Advantage beneficiaries to receive higher payments. Sutter Health does not admit any liability in the matter.
At the Abarca Forward conference earlier this year, George Van Antwerp, managing director at Deloitte, discussed how social determinants of health and a personalized member experience can improve medication adherence and health outcomes.
The government has intervened in complaints alleging Kaiser Permanente entities defrauded Medicare out of "tens of millions of dollars" by knowingly submitting false diagnoses for Medicare Advantage beneficiaries. Kaiser denies the allegations, saying it is in compliance with program requirements.
The agency charged the co-founders of the failed fecal microbiome startup with defrauding investors. The SEC is seeking a court order that would bar uBiome’s co-founders from serving as officers or directors, and require them to give up any ill-gotten gains.
The investigation resulted in charges against more than 345 defendants for more than $6 billion in alleged fraud losses. Roughly $4.5 billion of that was connected to telemedicine, the Department of Justice said.
The U.S. filed a lawsuit against Anthem alleging the insurer knowingly failed to correct inaccurate diagnosis codes for patients enrolled in its Medicare Advantage plans.
We will highlight Build My Health's revenue practice management tools, which could help physician practices add up to $250,000 to their practices.
The Department of Justice sued Omnicare for allegedly dispensing drugs without valid prescriptions.
Various news outlets reported that attorneys for Holmes successfully convinced a federal judge to delay setting a trial date in order to get more time to review some 20 million pages of documents.
After an eight-week trial, Philip Esformes was found guilty for his role in a fraud scheme that involved more than $1.3 billion in fraudulent claims to Medicare and Medicaid for services that weren't provided, weren't medically necessary or were procured through the payment of kickbacks.
Despite a couple of flaws, Alex Gibney's new film - airing March 18 - expertly portrays how Elizabeth Holmes's dream of changing the world of lab testing became a fraud.
Wisam Rizk, the ex-CTO of the spinoff business, pleaded guilty to charges of wire fraud, conspiracy and making false statements and faces sentencing in March.