Mohamad Makki, a licensed pharmacist from Dearborn Heights, Mich., was sentenced to 77 months in prison and was ordered to pay $9.8 million in restitution and forfeit about $1.1 million for his role in a conspiracy to defraud health care insurers. Authorities said Makki and co-conspirators submitted fraudulent claims to Medicare, Medicaid and Blue Cross Blue Shield of Michigan for pharmaceuticals that were never dispensed, among other offenses.
Tri-State Specialists, a physician group in Sioux City, Iowa, agreed to a $612,501 settlement to resolve accusations that it violated the False Claims Act. Authorities said the group overbilled the Federal Employees Health Benefits Program, Tricare, Medicare and Medicaid for procedures in excess of those actually provided, as well as billed the health care programs for procedures that were medically unnecessary.
Brandy McKay, the owner of durable medical equipment firms in Missouri, was sentenced to three years in prison and ordered to pay more than $7.5 million in restitution after pleading guilty to Medicaid and Medicare fraud. According to her plea, McKay submitted reimbursement claims to Medicaid and Medicare for equipment that was ordered without any medical necessity between 2017 and 2019.
Duniel Tejeda of Clewiston, Fla., was sentenced to 30 months in prison and was ordered to pay $2.1 million in restitution after pleading guilty to charges connected to his engagement in a scheme to falsify clinical drug trial data. Court documents showed Tejeda, who worked at Miami-based Tellus Clinical Research, falsified data in medical records and falsely represented that subjects were part of clinical trials.
AHIP has filed an amicus brief backing HHS' position in a Texas Medical Association lawsuit challenging the No Surprises Act's billing dispute resolution process. AHIP said the qualifying payment amount used to resolve disputes under the law reflects "competitive, fair market rates," and that the medical association's suit would "create the very problems the Act aims to remedy."
Analysis of wastewater in 25 states is offering public health officials insight into coronavirus levels in different communities. Amy Kirby of the National Wastewater Surveillance System said human fecal viral load that ends up in sewage can be seen as "not just an early warning sign, but it's also helpful to monitor the full trajectory of a surge."
Belgium's UCB has acquired Zogenix in a $1.9 billion deal to expand its portfolio of epilepsy treatments and rare disease drugs. The deal focuses on the company's epilepsy drug Fintepla, which is used as a treatment for Dravet syndrome.
Chief executive officers in a PURE Group of Insurance Companies roundtable offered advice and insights on leading effectively during periods of stress and uncertainty. Christine Miller of Melinta Therapeutics said one way of addressing constant change is to deploy an advisory group to coach executive teams, and Simon Freakley of AlixPartners said chief executive officers sometimes have to be prepared to function as their own chief communication officers.
A recently released research paper touts strategies financial advisors can use to bring advice to the masses at low cost. Among the suggestions are making sure the clients have some basic financial tools and skills in place and focusing on simple investments at the beginning.
The Wellcome Trust and the Bill & Melinda Gates Foundation have pledged $150 million each to fund the Coalition for Epidemic Preparedness Innovations' COVID-19 pandemic response and to support preparations for future disease threats. "The unprecedented spread of the highly infectious Omicron variant around the world over the past two months exemplifies the ways in which we must be ready both in terms of speed and the scale of our response to future threats," said CEPI CEO Richard Hatchett.