Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2019
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Pharmacy/Prescription Drug Fraud Tips for Protecting Yourself and Medicare
Pharmacy/Prescription Drug Fraud Tips for Protecting Yourself and Medicare Pharmacy and prescription drug fraud is a consistent trend in Medicare. Due to the lucrative nature of prescription drug diversion and pharmacy scams, criminals continue to exploit Medicare Part D. What is Medicare Pharmacy/Prescription Drug Fraud? Although there are many types of prescription drug schemes, pharmacy fraud primarily occurs when Medicare is billed for a medication that was not received or a beneficiary is intentionally given a different prescription drug than prescribed. What are Examples of Pharmacy/Prescription Drug Fraud? • Billing Medicare for prescription drugs (including refills) that were never picked up, delivered, or even prescribed. • Billing Medicare for prescription drugs (occasionally controlled substances such as opioids) that were prescribed by a health care provider you have never seen. • Billing Medicare for medication amounts beyond the quantity you were prescribed. • Billing Medicare for a different prescription drug (often more expensive) than the one you were originally prescribed or issuing you a drug that is not approved by the U.S. Food and Drug Administration (FDA). • A pharmacy that intentionally provides less medication than prescribed. • A pharmacy that issues expired drugs. • A pharmacy that provides and bills for an expensive compounded medication, including topical pain creams, when a traditional or less expensive prescription was ordered by your provider. • A company offering you “free” or “discount” prescription drugs without a treating physician’s order and then billing Medicare. • A pharmacy offering gift cards or other compensation so you switch your prescriptions over to a specific pharmacy. • A pharmacy automatically refilling a prescription you no longer need. -
Mail Fraud: Opening Letters
South Carolina Law Review Volume 43 Issue 2 Article 3 Winter 1992 Mail Fraud: Opening Letters Ellen S. Podgor Georgia State University College of Law Follow this and additional works at: https://scholarcommons.sc.edu/sclr Part of the Law Commons Recommended Citation Podgor, Ellen S. (1992) "Mail Fraud: Opening Letters," South Carolina Law Review: Vol. 43 : Iss. 2 , Article 3. Available at: https://scholarcommons.sc.edu/sclr/vol43/iss2/3 This Article is brought to you by the Law Reviews and Journals at Scholar Commons. It has been accepted for inclusion in South Carolina Law Review by an authorized editor of Scholar Commons. For more information, please contact [email protected]. Podgor: Mail Fraud: Opening Letters SOUTH CAROLINA LAW REVIEW VOLUME 43 WINTER 1992 NUMBER 2 MAIL FRAUD: OPENING LETTERS ELLEN S. PODGOR* I. INTRODUCTION ....................................... 224 II. ELEMENTS ........................................... 225 A. First Element-Scheme to Defraud ............... 226 B. Second Element-Mailing in Furtherance of Schem e ........................................ 229 C. Mail Fraud As It Relates to Wire Fraud and RICO 231 III. SCHEME TO DEFRAUD ................................. 232 A. Intangible Rights Doctrine ....................... 232 B. 1346 Ramifications .............................. 236 IV. IN FURTHERANCE ..................................... 239 A . Conduct ........................................ 240 B. Lim itations ..................................... 242 1. Conflicts with Scheme to Defraud............. 243 2. Imperative Duty Imposed by State ........... 245 3. Mailing Prior to Commencement of Scheme ... 247 * Associate Professor of Law, Georgia State University College of Law. B.S. 1973, Syracuse University; J.D. 1976, Indiana University School of Law at Indianapolis; M.B.A. 1987, University of Chicago; L.L.M. 1989, Temple University School of Law. The author wishes to thank Professors Alfredo Garcia, Eli Lederman, and Laura Webster for their helpful comments throughout the drafting of this article. -
Hot Topics in Fraud and Abuse Enforcement Involving Health Care Providers
Hot Topics in Fraud and Abuse Enforcement Involving Health Care Providers Stephen C. Payne (moderator) Winston Y. Chan John D. W. Partridge Jonathan M. Phillips September 22, 2016 Agenda • Applicable Law • Enforcement Trends • Enforcement Theories • Recent Legal Developments • Questions 2 Applicable Law The False Claims Act (FCA) • The FCA, 31 U.S.C. §§ 3729-3733, is the federal government’s primary weapon to redress fraud against government agencies and programs. • The FCA provides for recovery of civil penalties and treble damages from any person who knowingly submits or causes the submission of false or fraudulent claims to the United States for money or property. “It seems quite clear that the objective of Congress was broadly • Under the FCA, the Attorney General, through DOJ to protect the funds attorneys, investigates and pursues FCA cases (except in and property of the declined qui tam cases). Government from fraudulent claims ….” Rainwater v. United States, 356 U.S. 590 (1958) 4 FCA – Key Provisions 31 U.S.C. Statutory Prohibition Summary § 3729(a)(1) (A) Knowingly presents, or causes to be presented, False/Fraudulent Claim a false or fraudulent claim for payment or approval (B) Knowingly makes, uses or causes to be made or False used, a false record or statement material to a Record/Statement false or fraudulent claim (C) Knowingly conceals or knowingly and improperly “Reverse” False Claim avoids or decreases an obligation to pay or transmit money or property to the Government (G) Conspires to violate a liability provision of -
White Collar Crime by Health Care Providers Pamela H
NORTH CAROLINA LAW REVIEW Volume 67 | Number 4 Article 7 4-1-1989 Fraud by Fright: White Collar Crime by Health Care Providers Pamela H. Bucy Follow this and additional works at: http://scholarship.law.unc.edu/nclr Part of the Law Commons Recommended Citation Pamela H. Bucy, Fraud by Fright: White Collar Crime by Health Care Providers, 67 N.C. L. Rev. 855 (1989). Available at: http://scholarship.law.unc.edu/nclr/vol67/iss4/7 This Article is brought to you for free and open access by Carolina Law Scholarship Repository. It has been accepted for inclusion in North Carolina Law Review by an authorized administrator of Carolina Law Scholarship Repository. For more information, please contact [email protected]. FRAUD BY FRIGHT: WHITE COLLAR CRIME BY HEALTH CARE PROVIDERSt PAMELA H. Bucyt Fraudby health care providers is one of the most deleterious of all white collar crimes. It is also one of the most difficult to prosecute. In her Article, ProfessorBucy comparesfraud by health care providers with other types of white collar crime and analyzes the theories offraud his- torically used to prosecute health careproviders. She concludes that the strongest theory--prosecutionfor providing unnecessary or substandard health care-is the theory that has been used the least. ProfessorBucy suggests ways for prosecutors to use this theory more often and more effectively in order to combat a problem that ravishes human dignity and personal health as well as the nationalpocketbook "I will apply measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice." Portion of Oath of Hippocrates, Sixth Century B.C.- First Century A.D.; currently administered by many medical schools to graduating medical students.1 "[I c]ould make a million dollars out of the suckers ..... -
Regulation of Dietary Supplements Hearing
S. HRG. 108–997 REGULATION OF DIETARY SUPPLEMENTS HEARING BEFORE THE COMMITTEE ON COMMERCE, SCIENCE, AND TRANSPORTATION UNITED STATES SENATE ONE HUNDRED EIGHTH CONGRESS FIRST SESSION OCTOBER 28, 2003 Printed for the use of the Committee on Commerce, Science, and Transportation ( U.S. GOVERNMENT PUBLISHING OFFICE 20–196 PDF WASHINGTON : 2016 For sale by the Superintendent of Documents, U.S. Government Publishing Office Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800 Fax: (202) 512–2104 Mail: Stop IDCC, Washington, DC 20402–0001 VerDate Nov 24 2008 11:04 May 24, 2016 Jkt 075679 PO 00000 Frm 00001 Fmt 5011 Sfmt 5011 S:\GPO\DOCS\20196.TXT JACKIE SENATE COMMITTEE ON COMMERCE, SCIENCE, AND TRANSPORTATION ONE HUNDRED EIGHTH CONGRESS FIRST SESSION JOHN MCCAIN, Arizona, Chairman TED STEVENS, Alaska ERNEST F. HOLLINGS, South Carolina, CONRAD BURNS, Montana Ranking TRENT LOTT, Mississippi DANIEL K. INOUYE, Hawaii KAY BAILEY HUTCHISON, Texas JOHN D. ROCKEFELLER IV, West Virginia OLYMPIA J. SNOWE, Maine JOHN F. KERRY, Massachusetts SAM BROWNBACK, Kansas JOHN B. BREAUX, Louisiana GORDON SMITH, Oregon BYRON L. DORGAN, North Dakota PETER G. FITZGERALD, Illinois RON WYDEN, Oregon JOHN ENSIGN, Nevada BARBARA BOXER, California GEORGE ALLEN, Virginia BILL NELSON, Florida JOHN E. SUNUNU, New Hampshire MARIA CANTWELL, Washington FRANK R. LAUTENBERG, New Jersey JEANNE BUMPUS, Republican Staff Director and General Counsel ROBERT W. CHAMBERLIN, Republican Chief Counsel KEVIN D. KAYES, Democratic Staff Director and Chief Counsel GREGG ELIAS, Democratic General Counsel (II) VerDate Nov 24 2008 11:04 May 24, 2016 Jkt 075679 PO 00000 Frm 00002 Fmt 5904 Sfmt 5904 S:\GPO\DOCS\20196.TXT JACKIE C O N T E N T S Page Hearing held on October 28, 2003 ......................................................................... -
Prescription Drug Fraud and Misuse, 2Nd Edition
Problem-Specific Guides Series Problem-Oriented Guides for Police No. 24 Prescription Drug Fraud and Misuse 2nd Edition Julie Wartell and Nancy G. La Vigne Problem-Oriented Guides for Police Series Problem-Specific Guide No. 24 Prescription Drug Fraud and Misuse 2nd Edition Julie Wartell Nancy G. La Vigne This project was supported by cooperative agreement #2010-CK-WX-K005 awarded by the Office of Community Oriented Policing Services, U.S. Department of Justice. The opinions contained herein are those of the author(s) and do not necessarily represent the official position or policies of the U.S. Department of Justice. References to specific agencies, companies, products, or services should not be considered an endorsement of the product by the author(s) or the U.S. Department of Justice. Rather, the references are illustrations to supplement discussion of the issues. The Internet references cited in this publication were valid as of the date of this publication. Given that URLs and websites are in constant flux, neither the author(s) nor the COPS Office can vouch for their current validity. © 2013 Center for Problem-Oriented Policing, Inc. The U.S. Department of Justice reserves a royalty-free, nonexclusive, and irrevocable license to reproduce, publish, or otherwise use, and authorize others to use, this publication for Federal Government purposes. This publication may be freely distributed and used for noncommercial and educational purposes. www.cops.usdoj.gov ISBN: 978-1-932582-37-6 April 2013 Originally published May 2004 Updated -
Task Force Initial Six Month Report
I Initial Six-Month Report October 2016 Table of Contents Page 1 Page 2 Page 3 I. Executive Summary the Office of Inspector General for the Department of Healthcare and Family Services (“HFS-OIG”) will report $220.2 million in savings, recoupment, and avoidance in the State Medicaid program (references to Medicaid savings and recoveries include State and federal dollars). In addition, during federal FY 2015, referrals to the Illinois State Police Medicaid Fraud Control Unit (“ISP-MFCU”) led to 42 fraud convictions and $16.9 million in recoveries through criminal prosecutions, civil actions, and/or administrative referrals.4 In addition to the Medicaid program, the State of Illinois also administers insurance for over The Illinois Health Care Fraud Elimination Task 450,000 State employees, dependents, and retirees,5 and Force (the “Task Force”) is pleased to submit this six- administers the Workers’ Compensation Program for month report, detailing the Task Force’s fraud, waste, and approximately 100,000 State employees. State employee abuse identification efforts, to Governor Bruce Rauner. health insurance benefits cost Illinois taxpayers State of Illinois (“State”) government-administered approximately $3 billion on an annual basis.6 For FY health care programs provide important services to 2017, the Illinois Department of Central Management citizens and State employees. The State, however, must Services (“Illinois CMS”) estimates the liability for be ever-diligent in the administration and monitoring employee health insurance benefits to be $2.86 billion.7 of such programs in order to ensure that taxpayer funds This estimate represents a 4.1 percent growth rate from are being spent properly and in the best interest of the FY 2016 to FY 2017.8 The State’s cost per participant taxpayers. -
Fostering Innovation to Fight Waste, Fraud, and Abuse in Health Care
FOSTERING INNOVATION TO FIGHT WASTE, FRAUD, AND ABUSE IN HEALTH CARE HEARING BEFORE THE SUBCOMMITTEE ON HEALTH OF THE COMMITTEE ON ENERGY AND COMMERCE HOUSE OF REPRESENTATIVES ONE HUNDRED THIRTEENTH CONGRESS FIRST SESSION FEBRUARY 27, 2013 Serial No. 113–10 ( Printed for the use of the Committee on Energy and Commerce energycommerce.house.gov U.S. GOVERNMENT PRINTING OFFICE 80–160 WASHINGTON : 2013 For sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800 Fax: (202) 512–2104 Mail: Stop IDCC, Washington, DC 20402–0001 VerDate Nov 24 2008 12:32 May 15, 2013 Jkt 037690 PO 00000 Frm 00001 Fmt 5011 Sfmt 5011 F:\MY DOCS\HEARINGS 113\113-10 CHRIS COMMITTEE ON ENERGY AND COMMERCE FRED UPTON, Michigan Chairman RALPH M. HALL, Texas HENRY A. WAXMAN, California JOE BARTON, Texas Ranking Member Chairman Emeritus JOHN D. DINGELL, Michigan ED WHITFIELD, Kentucky Chairman Emeritus JOHN SHIMKUS, Illinois EDWARD J. MARKEY, Massachusetts JOSEPH R. PITTS, Pennsylvania FRANK PALLONE, JR., New Jersey GREG WALDEN, Oregon BOBBY L. RUSH, Illinois LEE TERRY, Nebraska ANNA G. ESHOO, California MIKE ROGERS, Michigan ELIOT L. ENGEL, New York TIM MURPHY, Pennsylvania GENE GREEN, Texas MICHAEL C. BURGESS, Texas DIANA DEGETTE, Colorado MARSHA BLACKBURN, Tennessee LOIS CAPPS, California Vice Chairman MICHAEL F. DOYLE, Pennsylvania PHIL GINGREY, Georgia JANICE D. SCHAKOWSKY, Illinois STEVE SCALISE, Louisiana ANTHONY D. WEINER, New York ROBERT E. LATTA, Ohio JIM MATHESON, Utah CATHY MCMORRIS RODGERS, Washington G.K. BUTTERFIELD, North Carolina GREGG HARPER, Mississippi JOHN BARROW, Georgia LEONARD LANCE, New Jersey DORIS O. -
Unconventional Cancer Treatments
Unconventional Cancer Treatments September 1990 OTA-H-405 NTIS order #PB91-104893 Recommended Citation: U.S. Congress, Office of Technology Assessment, Unconventional Cancer Treatments, OTA-H-405 (Washington, DC: U.S. Government Printing Office, September 1990). For sale by the Superintendent of Documents U.S. Government Printing OffIce, Washington, DC 20402-9325 (order form can be found in the back of this report) Foreword A diagnosis of cancer can transform abruptly the lives of patients and those around them, as individuals attempt to cope with the changed circumstances of their lives and the strong emotions evoked by the disease. While mainstream medicine can improve the prospects for long-term survival for about half of the approximately one million Americans diagnosed with cancer each year, the rest will die of their disease within a few years. There remains a degree of uncertainty and desperation associated with “facing the odds” in cancer treatment. To thousands of patients, mainstream medicine’s role in cancer treatment is not sufficient. Instead, they seek to supplement or supplant conventional cancer treatments with a variety of treatments that exist outside, at varying distances from, the bounds of mainstream medical research and practice. The range is broad—from supportive psychological approaches used as adjuncts to standard treatments, to a variety of practices that reject the norms of mainstream medical practice. To many patients, the attractiveness of such unconventional cancer treatments may stem in part from the acknowledged inadequacies of current medically-accepted treatments, and from the too frequent inattention of mainstream medical research and practice to the wider dimensions of a cancer patient’s concerns. -
Annual Report 2020
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 20-F ☐ REGISTRATION STATEMENT PURSUANT TO SECTION 12(b) OR (g) OF THE SECURITIES EXCHANGE ACT OF 1934 OR ☒ ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the fiscal year ended December 31, 2020 OR ☐ TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 OR For the transition period from _____ to ______ ☐ SHELL COMPANY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 Date of event requiring this shell company report ________________ Commission file number 001-35165 BrainsWay Ltd. (Exact name of Registrant as specified in its charter) N/A (Translation of Registrant’s name into English) Israel (Jurisdiction of incorporation or organization) 19 Hartum Street, Bynet Building, 3rd Floor, Har HaHotzvim, Jerusalem, 9777518, Israel (Address of principal executive offices) Hadar Levy, Senior Vice President, General Manager North America and Interim Chief Financial Officer 300 Knickerbocker Road, Cresskill, New Jersey, 07626 Tel: +1-844-386-7001 (Name, Telephone, E-mail and/or Facsimile number and Address of Company Contact Person) Securities registered or to be registered pursuant to Section 12(b) of the Act. Title of class Trading Symbol(s) Name of each exchange on which registered American Depositary Shares, each representing two Ordinary Shares BWAY NASDAQ Global Market (1) Ordinary Shares, par value NIS 0.04 per share BWAY Tel Aviv Stock Exchange (1) Evidenced by American Depositary Receipts. Securities registered or to be registered pursuant to Section 12(g) of the Act: None (Title of Class) Securities for which there is a reporting obligation pursuant to Section 15(d) of the Act: None (Title of Class) Indicate the number of outstanding shares of each of the issuer’s classes of capital or common stock as of the close of the period covered by the annual report: 22,250,534 Ordinary Shares. -
Healthcare Fraud & Abuse Review 2017
HEALTHCARE FRAUD & ABUSE REVIEW 2017 i | BASS, BERRY & SIMS HEALTHCARE FRAUD & ABUSE REVIEW 2017 1. A LOOK BACK…A LOOK AHEAD 4. NOTEWORTHY SETTLEMENTS 7. ISSUES TO WATCH 12. FALSE CLAIMS ACT UPDATE 37. STARK LAW/ANTI-KICKBACK STATUTE 40. PHARMACEUTICAL AND MEDICAL DEVICE DEVELOPMENTS 42. APPENDIX – 2017 NOTABLE SETTLEMENTS Hospitals and Health Systems Managed Care/Insurance Hospice Laboratory, Pathology, Radiology and Diagnostics Home Health Specialty Care and Other Provider Entities SNFs and Nursing Homes Individual Providers Pharmaceutical and Device Miscellaneous/Non-Providers Pharmacy Services 70. ABOUT BASS, BERRY & SIMS General (HHS-OIG), along with federal and state law enforcement entities, including 30 Medicaid Fraud Control Units, charged more than 400 defendants, including 115 healthcare professionals, A LOOK BACK… in 41 federal districts for allegedly participating in fraudulent healthcare arrangements resulting in over $1.3 billion in false claims.6 A LOOK AHEAD Occurring in the context of combatting the opioid crisis, the takedown focused on individuals allegedly involved in fraudulent billing of Medicare, Medicaid and TRICARE for medically While the uncertainty associated with legislative efforts to repeal unnecessary prescription and compounded drugs that were not actually purchased or distributed to patients covered by a federal healthcare program. In total, more than 120 the Patient Protection and Affordable Care Act (PPACA) dominated defendants, including physicians, were charged in connection with prescribing and distributing most of the headlines for the healthcare industry last year, it was opioids and narcotics. Nearly 300 individuals—including physicians, nurses and pharmacists— mostly business as usual for the government’s healthcare fraud received exclusion notices from HHS-OIG barring future participation in federal healthcare 7 enforcement efforts. -
Health Care Fraud
Westlaw Journal Formerly Andrews Litigation Reporter HEALTH CARE FRAUD Litigation News and Analysis • Legislation • Regulation • Expert Commentary VOLUME 15, ISSUE 9 / MARCH 2010 Expert Analysis Health Care Compliance in 2009 And Going Forward: Part 1 By Debra Wong Yang, Esq., Nick Hanna, Esq. and Alexander H. Southwell, Esq. Gibson, Dunn & Crutcher Enforcement in the health care compliance arena exploded in 2009, with more en- forcement actions, bigger financial penalties, tougher settlement terms and higher stakes for individuals — including prison sentences. Many of the top companies in the health care industry found themselves in the government’s cross hairs last year, with some entering into record-breaking settlements. But smaller players were hardly immune from scrutiny, with many similarly target- ed in 2009. This increased regulatory and prosecutorial emphasis on health care compliance was hardly an anomaly; all signs point to a continuation of this upward trend in 2010 and beyond. With the current push for reform, health care’s significance in the American dialogue increased markedly last year. The multitrillion-dollar question at the center of the current debate is how to provide quality health care to the American public, including the millions of people who lack health insurance, while keeping costs manageable and eliminating waste. A key factor cited in the rising costs is health care fraud, and combating fraud is often depicted as a silver bullet. Against this backdrop, prosecutors and regulators are focusing with increasing inten- sity on issues of health care compliance. Tapping into public anger over rising costs and reports of abuse, more and more politicians and public officials look to assign blame for perceived or actual problems in the current system.