June 2018 Article

Medicare Fraud and Bribery Leads to Indictment

In Tennessee, the CEO of a medical device company has been indicted for conspiracy and bribery. CEO Brenda Montgomery paid bribes to those who referred customers to the company. Montgomery then billed Medicare for over $2.5 million in fraudulent claims to pay for the bribes and earn her “cut.” A Conflict of Interest program should be in place in any healthcare organizations to monitor and prevent the enticement of bribery.

“The bust was part of a nationwide health care fraud takedown, which led to hundreds of arrests in a host of unconnected cases across the nation” reports Tennessean. This particular bribery conspiracy is said to have been a six year operation. Montgomery was already accused of a bribery case in April, in which she paid pain management company CEO John Davis for referring business to her medical device company.

A comprehensive Conflict of Interest program requires employees to report any outside payments received. The Physician Sunshine Provision requires manufacturers to report any payments to physicians/teaching hospitals above $10. The payments are then open to the public for transparency in determining wether their referral to a particular doctor, surgeon, or treatment is in the best interest of the patient.

Additionally, the HealthDox COI Solution contains a comprehensive Division of Financial Responsibility (DOFR) model. Your healthcare organization will not find itself reporting fraudulent claims to Medicare or insurance companies, knowingly or unknowing. Within a healthcare organization, its difficult to ensure everyone is following correct decorum, but HealthDox COI Solution can help keep you on top of everything. To ensure your healthcare organization does not fall into fraud and extinction, request a HealthDox Conflict of Interest demo today!

Conflict of Interest

In the healthcare industry it is essential to be proactive when addressing compliance regulations. When potential Conflict of Interest (COI) issues arise, you need to have a quality policy to identify, track, and manage the COI. The HealthDox Conflict of Interest solution identifies potential COI and implements management plans and corrective actions to address the issue. The HealthDox COI solution also integrates custom Division of Financial Responsibility (DOFR) templates, Docusign for DOFR acknowledgement, and management committee review. To learn more about the features of HealthDox COI solution, request a demo today!

Let us help you manage the integrity of your company, discover how our Conflict of Interest solution can help.

Dallas Hospital Influences Doctors with Kickbacks and Bribes

Surgeons and physicians at Forest Park Medical Center were paid large sums to encourage patients to receive treatment. In West Texas, Shawn Henry referred patients to Forest Park Medical Center, knowing the Dallas Hospital was an inconvenient five hours away. The bankrupt and now defunct Forest Park Medical Center (FPMC) even went as far as paying for patient’s travel and lodging expenses just so they would agree to be seen at FPMC. In order to ensure your healthcare organization is engaging in practices in the best interest of the patient, be sure to have a compliant Conflict of Interest program. In addition to Henry, many doctors at this hospital were involved in the operation which spanned many years. In an effort to earn a quick buck, these doctors lost sight of their principles and integrity and led their organization into corruption. A cofounder of the hospital “was quoted in court documents in the case as saying, ‘We need more bodies on the table,’ about surgeries at Forest Park Medical Center” (Krause, DallasNews). Seeing patients as numbers instead of individuals who require unique care is a frightening practice. Surgery is a very invasive process as well as a financial burden, trying to get “more bodies on the table,” puts anyone seen there at risk.

Due to financial troubles and rampant corruption, the medical center ultimately failed. Putting patients at risk by means of encouraging surgery consultations and being blinded by money, these doctors failed their Hippocratic Oath.

A Conflict of Interest program in place, such as the solution offered by HealthDox, would have kept this hospital running ethically. HealthDox COI requires payments to be reviewed by a board, enforcing a sense of accountability. Additionally, new requirements allow anyone to access information pertaining to out of network doctor payments, giving patients the power to determine if their doctors have any potential conflict of interests at hand. Learn how HealthDox COI can keep your organization ethically sound and in business for many years to come, request a demo here!