Kusserow on Compliance: New FBI warning about scammers and the COVID-19 crisis

On March 20th, the FBI issued a new warning to the public about a rise in schemes related to the coronavirus (COVID-19) pandemic. The FBI warned to guard against opening documents and to research sources before clicking on links purporting to provide information on the virus; donating to a charity online or through social media; contributing to a crowdfunding campaign; purchasing products online; or giving up your personal information in order to receive money or other benefits. The FBI specifically warned to look out for fake CDC, NIH, HHS, and CMS emails. The agency noted to be particularly wary of websites and apps claiming to track COVID-19 cases worldwide and phishing emails asking to verify personal information in order to receive an economic stimulus check from the government. The fact is that government agencies are not sending unsolicited emails seeking private information in order to send money. The FBI also urges the public to be cautious of anyone selling products that claim to prevent, treat, diagnose, or cure COVID-19.  Other new scams involve seeking charitable contributions, financial relief airline carrier refunds, fake cures and vaccines, and fake testing kits. Failing to follow this advice can permit fraudsters to use links in emails to deliver malware to computers to steal personal information or to lock the computer and demand payment. With the current crisis, the FBI is concerned that many will lower their guard against scammers and, therefore, need to be reminded about these threats.

Tips for Compliance and Privacy Officers

  • Alert employees to beware of COVID-19 communications
  • Remind employees to not click on email links/attachment, or respond to inquiries
  • Regularly test users to make sure they are on guard
  • Configure email servers to block zip or other files that are likely to be malicious

 

Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

Connect with Richard Kusserow on LinkedIn.

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Copyright © 2020 Strategic Management Services, LLC. Published with permission.

Kusserow on Compliance: DOJ moves against spine device manufacturer for paying kickbacks

The Department of Justice (DOJ) has intervened in a qui tam whistleblower case filed against SpineFrontier, Inc. and related entities and executives for alleging paying kickbacks to spine surgeons to induce use of their surgical devices. According to the complaint, spine surgeons were given over $8 million in sham “consulting” payments ostensibly for product evaluations, when in fact the payments were for use of SpineFrontier devices.

The defendants allegedly created Impartial Medical Experts LLC IME—a purported consulting company—as an entity intermediary to funnel kickbacks to spine surgeons. IME was designed to shield the defendants and spine surgeons from government scrutiny by creating a false impression that surgeons were consulting through an independent third-party entity. The Defendants generally paid “consulting” spine surgeons $500 for a cervical procedure, and $1,000 for a lumbar procedure—but only if the surgeon used SpineFrontier devices. The United States alleges that consulting spine surgeons often performed little or no work beyond implanting the devices—for which they were separately paid by insurers—and that the Defendants did not systematically collect or use feedback from consultants and paid them even when they had provided no feedback at all.

Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

Connect with Richard Kusserow on LinkedIn.

Subscribe to the Kusserow on Compliance Newsletter

Copyright © 2020 Strategic Management Services, LLC. Published with permission.

Kusserow on Compliance: Is there no limit to fraud cases?

Doctor convicted in connection to a $325 million fraud case

Falsely diagnosing patients with lifelong illnesses

Needlessly subjected patients to unnecessary medications

A Texas rheumatologist was convicted in a jury trial in connection with a $325 million healthcare fraud case. He was found guilty of falsely diagnosing patients with lifelong illnesses and needlessly subjecting them to unnecessary medications such as chemotherapy drugs and then falsely billing insurers for millions of dollars. The DOJ saw this as an extremely egregious case because the doctor falsely diagnosed vulnerable patients—the young, elderly and disabled—with life-long diseases requiring invasive treatments that those patients did not in fact need.

The DOJ further noted that many of the patients, including one as young as 13, suffered physical and emotional harm as a result of the chemotherapy injections, hours’ long intravenous infusions, and other excessive, repetitive and profit-driven medical procedures. Also noted was that the evidence presented at trial showed that to obstruct and mislead a federal grand jury investigation, the doctor falsified medical records.

 

Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

Connect with Richard Kusserow on LinkedIn.

Subscribe to the Kusserow on Compliance Newsletter

Copyright © 202o Strategic Management Services, LLC. Published with permission.

Kusserow on Compliance: DOJ reports 2019 False Claims Act Recoveries of over $3B

The DOJ obtained more than $3 billion in settlements and judgments from civil cases involving fraud and false claims against the government in fiscal year 2019. Recoveries since 1986, when Congress substantially strengthened the civil False Claims Act, now total more than $62 billion. Of the more than $3 billion in settlements and judgments recovered, $2.6 billion related to the health care industry.

This was the tenth consecutive year that health care fraud settlements and judgments have exceeded $2 billion. Whistleblower, or qui tam, actions comprise a significant percentage of the False Claims Act cases that are filed. Of the $3 billion in settlements and judgments reported by the government in fiscal year 2019, over $2.1 billion arose from lawsuits filed under the qui tam provisions of the False Claims Act.

During the same period, the government paid out $265 million to the individuals who exposed fraud and false claims by filing these actions. The number of lawsuits filed under the qui tam provisions of the Act has grown significantly since 1986, with 633 qui tam suits filed this past year—an average of more than 12 new cases every week. In its news release, the DOJ noted that it had increased holding individuals accountable and cited examples of actions taken against responsible executives.

Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

Connect with Richard Kusserow on LinkedIn.

Subscribe to the Kusserow on Compliance Newsletter

Copyright © 2020 Strategic Management Services, LLC. Published with permission.