When I was first hired as an OIG Agent, I was told by numerous people that fraud in the Medicare Advantage (MA) world was difficult to commit, and ever more difficult to prove. To put it into context, it was the mid-1990s, and MA plans were not where they are today. That being said, I always…
What is most important: identify, eliminate, recover or (PLOT TWIST) prevent? Coming off of a strong week of meetings with my clients and listening to their real pain points coupled with listening to hours of the podcast Do You Know This Man, and incessant Elizabeth Holmes reading and consumption, I sit on my 6am flight…
A Florida orthopedic surgeon and designer of costly spinal surgery implants was arrested Tuesday and charged with paying millions of dollars in kickbacks and bribes to surgeons who agreed to use his company’s devices. Dr. Kingsley R. Chin, 57, of Fort Lauderdale, Florida, is the founder, chief executive officer and owner of SpineFrontier, a device…
When the coronavirus hit Martha Leland’s Connecticut nursing home last year, she and dozens of other residents contracted the disease while the facility was on lockdown. Twenty-eight residents died, including her roommate. “The impact of not having friends and family come in and see us for a year was totally devastating,” she said. “And then,…
Aggressive sales tactics have allegedly led surgeons to use defective or wrong-size implants, screws or other products on patients, including former Olympian Mary Lou Retton.
The clock was about to strike midnight, and Scott Newman was desperately feeding pages into a scanner, trying to prevent thousands of dollars in prescription payments from turning into a pumpkin. As the owner of Newman Family Pharmacy, an independent drugstore in Chesapeake, Virginia, he was responding to an audit ordered by a pharmacy benefit…
Stephen Matthew Shumaker counted on in-home, in-person demonstrations to drive his water filtration business, which serves the Atlanta area. So when covid-19 hit and no one was inviting people indoors, he turned to the air-cleaning part of his operation. He sent cards in the mail advertising air purifiers using “ActivePure” technology to new homeowners: “KILL…
The care was ordinary. A hospital in Modesto, California, treated a 30-year-old man for shoulder and back pain after a car accident. He went home in less than three hours. The bill was extraordinary. Sutter Health Memorial Medical Center charged $44,914 including an $8,928 “trauma alert” fee, billed for summoning the hospital’s top surgical specialists…
Dr. Kingsley R. Chin was little more than a decade out of Harvard Medical School when sales of his spine surgical implants took off. Chin has patented more than 40 pieces of such hardware, including doughnut-shaped plastic cages, titanium screws and other products used to repair spines — generating $100 million for his company SpineFrontier,…
The pandemic has highlighted poor care in America’s nursing homes, where nearly 175,000 people have died of covid-19 — a third of all deaths from the disease nationwide. Even before the pandemic, patient advocates pointed to dangerous conditions in U.S. nursing homes, including staffing shortages and infection control failures. Many nursing homes didn’t provide quality care, they charged. Studies have found that…