At the last minute, President Donald Trump granted pardons to several individuals convicted in huge Medicare swindles that prosecutors alleged often harmed or endangered elderly and infirm patients while fleecing taxpayers.
The Justice Department has thus far declined to take over the case, which alleges wrongdoing by Seattle-based nonprofit health plan, Group Health, but said in a June 21 court filing that “an active investigation is ongoing.”
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.
While prescriptions for durable medical equipment, such as orthotic braces or wheelchairs, have long been a staple of Medicare fraud schemes, the manipulation of telemedicine is relatively new.
Suspects in the case include executives at five telemedicine companies, the owners of dozens of durable medical equipment (DME) companies and three licensed medical professionals.
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.
According to the DOJ, this is the ninth consecutive year that the organizations' civil healthcare fraud settlements and judgments have exceeded $2 billion.
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.