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Executives to pay for health care fraud - 5/31/2011 8:40:12 AM   
tazzygirl


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WASHINGTON — It's getting personal now. In a shift still evolving, federal enforcers are targeting individual executives in health care fraud cases that used to be aimed at impersonal corporations.

The new tactic is raising the anxiety level — and risks — for corporate honchos at drug companies, medical device manufacturers, nursing home chains and other major health care enterprises that deal with Medicare and Medicaid.
Previously, if a company got caught, its lawyers in many cases would be able to negotiate a financial settlement. The company would write the government a check for a number followed by lots of zeroes and promise not to break the rules again. Often the cost would just get passed on to customers.

Now, on top of fines paid by a company, senior executives can face criminal charges even if they weren't involved in the scheme but could have stopped it had they known. Furthermore, they can also be banned from doing business with government health programs, a career-ending consequence.


.........

Many in industry see the more aggressive strategy as government overkill, meting out radical punishment to individuals whose guilt prosecutors would be hard pressed to prove to a jury.

The feds say they got frustrated with repeat violations and decided to start using enforcement tools that were already on the books but had been allowed to languish. By some estimates, health care fraud costs taxpayers $60 billion a year, galling when Medicare faces insolvency.

"When you look at the history of health care enforcement, we've seen a number of Fortune 500 companies that have been caught not once, not twice, but sometimes three times violating the trust of the American people, submitting false claims, paying kickbacks to doctors, marketing drugs which have not been tested for safety and efficacy," said Lewis Morris, chief counsel for the inspector general of the Health and Human Services Department.

"To our way of thinking, the men and women in the corporate suite aren't getting it," Morris continued. "If writing a check for $200 million isn't enough to have a company change its ways, then maybe we have got to have the individuals who are responsible for this held accountable. The behavior of a company starts at the top."

........

A test case is playing out with an 83-year-old drug company chief executive, Howard Solomon of New York City-based Forest Laboratories. Forest makes antidepressants, blood pressure drugs and other medications. Last month, the inspector general's office notified Forest that Solomon could potentially be banned from doing business with federal programs.

The power to ban or "exclude" an individual rests with the inspector general. It's routinely applied to low-level violators, but rarely to people of Solomon's rank. In the industry, they call it the "death penalty."

Last year, a Forest subsidiary pleaded guilty to criminal charges as part of a settlement with the Justice Department in which the company also agreed to pay $313 million to resolve long-running investigations. Prosecutors charged that Forest deliberately ignored an FDA warning to stop distributing an unapproved thyroid drug, promoted the use of an antidepressant in treating children although it was only approved for adults and misled FDA inspectors making a quality check at a manufacturing plant.



http://www.msnbc.msn.com/id/43223962/ns/business-us_business/

This should be interesting to watch.

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RE: Executives to pay for health care fraud - 5/31/2011 8:52:58 AM   
flcouple2009


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Why couldn't we have done this a few years ago.  Rick Scott could be in jail instead of screwing up Florida.

As it is now, they create the fraud, rack in big bucks , and then pay a pittance of what they made back in fines.

The reward well out weighs the risk.


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RE: Executives to pay for health care fraud - 5/31/2011 9:01:51 AM   
DomKen


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quote:

ORIGINAL: flcouple2009

Why couldn't we have done this a few years ago.  Rick Scott could be in jail instead of screwing up Florida.

This was my first thought when I saw the news.

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RE: Executives to pay for health care fraud - 5/31/2011 9:05:59 AM   
tazzygirl


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Seems Forest was the first, and was slapped with the fine in 2010. Now they are telling him he will be banned from doing business with the government, in essence telling the Company that as long as he is at the helm, they wont deal with Forest.

Im liking this idea... alot!

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RE: Executives to pay for health care fraud - 5/31/2011 9:06:07 AM   
willbeurdaddy


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"Now, on top of fines paid by a company, senior executives can face criminal charges even if they weren't involved in the scheme but could have stopped it had they known"

So CEOs are expected to be mind readers? Any convictions on this basis will never hold up in higher court unless it can be proven the CEO was negligent in not knowing.

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RE: Executives to pay for health care fraud - 5/31/2011 9:07:54 AM   
mnottertail


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Ah, but a few million in or out of the till.......remember, thats why these captains of industry are being paid millions upon millions, because they assess risk and have intimate and unique knowledge.

Now, I have heard it said that ignorance is no excuse.... 

If you are running a criminal enterprise, as CEO you should know what business you are in.

< Message edited by mnottertail -- 5/31/2011 9:08:52 AM >


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RE: Executives to pay for health care fraud - 5/31/2011 9:08:52 AM   
tazzygirl


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The tests case is running, willbe.

According to court documents, Forest Pharmaceuticals began distributing Levothroid for treatment of hypothyroidism in the early 1990s without first obtaining Food and Drug Administration (FDA) approval. In 1997, the FDA, after determining that the drugs were medically necessary, gave manufacturers a certain amount of time to conduct the necessary studies and obtain FDA approval. In 2001, the FDA stated that it would continue to permit manufacturers of unapproved levothyroxine sodium drugs to distribute their unapproved drugs after Aug. 14, 2001, on certain conditions. One of those conditions was that any manufacturer which had not obtained approval needed to comply with a gradual distribution phase-down of its unapproved drug until it obtained FDA approval. According to court documents, Forest made a deliberate decision to continue distributing its unapproved Levothroid product in quantities far exceeding the amounts permitted by the FDA’s distribution phase-down plan.

The FDA sent a warning letter to Forest Pharmaceuticals on Aug. 7, 2003, informing the company that it was no longer entitled to distribute its unapproved Levothroid product.

According to prosecutors, after Forest received the letter, the company directed its employees at its St. Louis distribution center to work overtime until approximately 1:00 a.m. the following morning and, during that time, to continue shipping as much of its unapproved Levothroid as possible.


Think they dont have grounds?

_____________________________

Telling me to take Midol wont help your butthurt.
RIP, my demon-child 5-16-11
Duchess of Dissent 1
Dont judge me because I sin differently than you.
If you want it sugar coated, dont ask me what i think! It would violate TOS.

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RE: Executives to pay for health care fraud - 5/31/2011 9:11:14 AM   
TrekkieLP


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quote:

ORIGINAL: willbeurdaddy

So CEOs are expected to be mind readers?


Or they're expected to know what their company is doing. 


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RE: Executives to pay for health care fraud - 5/31/2011 9:15:45 AM   
pahunkboy


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That thyroid pill thing caused quite a fuss.  People who use it were very upset.


FR-= what took them so long?

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RE: Executives to pay for health care fraud - 5/31/2011 9:17:20 AM   
flcouple2009


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Ken,

I know someone who has multiple medical supply places and made a fortune off of medicaid.  In the end he paid a small fine (in comparison to what he made) to the government.  

The catch was he got hung by the post office on mail fraud charges concerning part of the business.  He did a year in a minimum security fed lock up.

He was no longer supposed to have any dealing with Medicaid.  Before he went away, the entire time he was incarcerated, and currently his business is still making money from Medicaid.

He has always joked that the year locked up was a great trade off for the money he banked. 

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RE: Executives to pay for health care fraud - 5/31/2011 9:18:27 AM   
thishereboi


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quote:

Im liking this idea... alot!




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RE: Executives to pay for health care fraud - 5/31/2011 9:20:26 AM   
Kana


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quote:

ORIGINAL: TrekkieLP

quote:

ORIGINAL: willbeurdaddy

So CEOs are expected to be mind readers?


Or they're expected to know what their company is doing. 




Yep. This sounds kinda similar to SOX-just the health care equivalent.


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RE: Executives to pay for health care fraud - 5/31/2011 9:54:34 AM   
OrionTheWolf


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A few years ago my family owned a Durable Medical Supply business. One of the things we discovered were the amount of contract sales people and Doctors that were willing to do whatever was necessary to get the sale through. We practiced due diligence though, and if we saw the same Doctor's name showing up on paperwork for many different patients, we would question the sales person, and inform them a second opinion was needed (and Medicare pays for), or documentation from a physical therapist. Many of these sales the contract sales person just took to another company, that would push it through.

When we reported some of these through the proper channels, within 6 months many of our very legitimate claims were having payments held for reviews. These reviews were first 30 days, then we received letters of it going to a board review within 60 days, and often we had to appeal the board reviews, which meant payment could take 180 days or longer. Odd coincidence that ever appel we made was upheld, that not a single one of our submissions were declared fraudulent. These types of delays continued until we closed the business due to so much being tied up in Medicare Accounts Receivable, and lack of incoming sales (due primarily to the sales people wanting a fast buck).

I believe our reviews were triggered because one of the stores we reported, was a national chain, that even has advertisements on TV. They guarantee that your power chair will be paid for by Medicare or Medicaid or you get it free. That corporation had a lot of pull for whatever reasons, and the last time I went by there, I saw cards for sales people that we had turned away because of questionable practices.

I asked someone that used to work there, and they said the liability waivers were put on the sales people, and releaved them from alot of due diligence themselves. Whether this was true or not I do not know.

But you know something is wrong, when you know the majority of sales contractors are just looking to push through claims, and they all migrate to a particularly large corporation. I will not and cannot name the company without evidence.

I also had a previous business client that is a major corporation that provides nursing home care. They purchased as a separate company, a medical supply distribution company. They set things up so that the actual profit is made at the end sale side, and everything else is pass through charges. This means their distribution company operated as close to a zero net profit as they could. I was told it was because of credits the nursing home company got. Again whether this is true I am not sure, and could not find anything on it.

I am glad they are going after execs though, because those guys know what is going on, and they just hide behind a lot of liability waivers and such. The sad part is I do not think it will clean up the industry a lot, as these large corporations have legal teams that are constantly finding ways to reduce what can happen to their clients, and they often contribute to many campaigns.

Until I see some substantial jail time for several of the executives of large health care corporations receive jail time, I think it is just a shifting around of what has always gone on.

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RE: Executives to pay for health care fraud - 5/31/2011 9:57:17 AM   
OrionTheWolf


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I know someone similar, except he got off with a fine and judgement to no longer be involved with Medicare. So instead his wife opened a company that is. Same thing going on, just a different name, and all he does is "consult" her on basic financial decisions, and not any medicare items (wink, wink, nudge, nudge).



quote:

ORIGINAL: flcouple2009

Ken,

I know someone who has multiple medical supply places and made a fortune off of medicaid.  In the end he paid a small fine (in comparison to what he made) to the government.  

The catch was he got hung by the post office on mail fraud charges concerning part of the business.  He did a year in a minimum security fed lock up.

He was no longer supposed to have any dealing with Medicaid.  Before he went away, the entire time he was incarcerated, and currently his business is still making money from Medicaid.

He has always joked that the year locked up was a great trade off for the money he banked. 


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When speaking of slaves people always tend to ignore this definition "One who is abjectly subservient to a specified person or influence."

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RE: Executives to pay for health care fraud - 5/31/2011 9:58:38 AM   
OrionTheWolf


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They are expected to practice due diligence, and be responsible for the company.


quote:

ORIGINAL: willbeurdaddy

"Now, on top of fines paid by a company, senior executives can face criminal charges even if they weren't involved in the scheme but could have stopped it had they known"

So CEOs are expected to be mind readers? Any convictions on this basis will never hold up in higher court unless it can be proven the CEO was negligent in not knowing.


_____________________________

When speaking of slaves people always tend to ignore this definition "One who is abjectly subservient to a specified person or influence."

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RE: Executives to pay for health care fraud - 5/31/2011 10:12:59 AM   
willbeurdaddy


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quote:

ORIGINAL: OrionTheWolf

They are expected to practice due diligence, and be responsible for the company.


quote:

ORIGINAL: willbeurdaddy

"Now, on top of fines paid by a company, senior executives can face criminal charges even if they weren't involved in the scheme but could have stopped it had they known"

So CEOs are expected to be mind readers? Any convictions on this basis will never hold up in higher court unless it can be proven the CEO was negligent in not knowing.



Exactly...not to be mind readers. There are two words in your phrase, the first is DUE.

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RE: Executives to pay for health care fraud - 5/31/2011 10:18:32 AM   
mnottertail


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"Now, on top of fines paid by a company, senior executives can face criminal charges even if they weren't involved in the scheme but could have stopped it had they known"

So CEOs are expected to be mind readers? Any convictions on this basis will never hold up in higher court unless it can be proven the CEO was negligent in not knowing.



So you set up the strawman and knock it down, very maladroitly.

Had they known.

Read the english that's there, not the strawman that an insurance peddler and shill would read. 

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RE: Executives to pay for health care fraud - 5/31/2011 10:22:49 AM   
tazzygirl


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They knew.

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Telling me to take Midol wont help your butthurt.
RIP, my demon-child 5-16-11
Duchess of Dissent 1
Dont judge me because I sin differently than you.
If you want it sugar coated, dont ask me what i think! It would violate TOS.

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RE: Executives to pay for health care fraud - 5/31/2011 11:19:07 AM   
OrionTheWolf


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Having been in the business the only way not to know is willful ignorance or turning a blind eye and hiding behind legalities. Sorry but everyone in the medical supply business knows how things are done, they just do not talk about it unless you are on the inside, or in their pocket.

quote:

ORIGINAL: willbeurdaddy


quote:

ORIGINAL: OrionTheWolf

They are expected to practice due diligence, and be responsible for the company.


quote:

ORIGINAL: willbeurdaddy

"Now, on top of fines paid by a company, senior executives can face criminal charges even if they weren't involved in the scheme but could have stopped it had they known"

So CEOs are expected to be mind readers? Any convictions on this basis will never hold up in higher court unless it can be proven the CEO was negligent in not knowing.



Exactly...not to be mind readers. There are two words in your phrase, the first is DUE.


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When speaking of slaves people always tend to ignore this definition "One who is abjectly subservient to a specified person or influence."

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RE: Executives to pay for health care fraud - 5/31/2011 11:43:50 AM   
willbeurdaddy


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quote:

ORIGINAL: OrionTheWolf

Having been in the business the only way not to know is willful ignorance or turning a blind eye and hiding behind legalities. Sorry but everyone in the medical supply business knows how things are done, they just do not talk about it unless you are on the inside, or in their pocket.

quote:

ORIGINAL: willbeurdaddy


quote:

ORIGINAL: OrionTheWolf

They are expected to practice due diligence, and be responsible for the company.


quote:

ORIGINAL: willbeurdaddy

"Now, on top of fines paid by a company, senior executives can face criminal charges even if they weren't involved in the scheme but could have stopped it had they known"

So CEOs are expected to be mind readers? Any convictions on this basis will never hold up in higher court unless it can be proven the CEO was negligent in not knowing.



Exactly...not to be mind readers. There are two words in your phrase, the first is DUE.



then they should and will be convicted. You're overstating the case though. The health business is no different than any other large business, and if some lower level people want to conspire in some manner to inflate their own bonuses/evaluations it can easily be done without detection for years without there being willful negligence.

< Message edited by willbeurdaddy -- 5/31/2011 11:50:13 AM >


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