Federal Investigation

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So, how can a healthcare director of billing be an executive of a lab, and state there is no conflict of interest? How can billing for labs, physician care, and pharmacy be done in one place, same billers, and there is no conflict of interest.
 








Cordant did not purchase Sterling, it was just a name change. Also Cordant is owned by Waud Capital who also owns Acadia Healthcare. Acadia sends business to Cordant even though both are controlled by Waud. Then they accept work from other entities. This is a Stark Violation and they should be put in jail for doing this!
 








anonymous said:
I can't speak for any of the other companies but Northwest Physicians Laboratories definitely has some sort of scam going on. I'm pretty sure they are cheating the Insurance companies. One drug test I was billed for was over $1,000. (And mine are not court ordered or anything like that.) The referring office Northwest Spine and Pain tells its patients not to pay the bill, just not to worry about it. Something is really off here. I hope the guy who said they are under investigation by the Feds is correct.
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So why is the FBI now reaching out to referring physicians? What kind of crap are they doing there?
 








Northwest Physician Labs is also part of Paramount Pharmacy and Accendant Labs. In the Wall Street Journal yesterday they stated that Accendant Labs was shut down for fraud. Northwest Physician Labs recently changed their name to Altius and are trying to dodge the FBI/DOD/and State Investigators.

All 3 of the companies are owned by Ryse Medical.
 








They sell memberships. The doctors buy so many shares and they get dividends from the lab. The more the lab orders they write the more money they receive.

I foresee jail time
 
















Does anyone know the name of the investigator who is looking into this I am very interested as I feel I was taken advantage of as a customer for years I did not know what was going on until I talked with a few other companies I was never offered any deals price breaks until I went to a conference and found out that others were.
 
























Days are numbered at NWPL, Ryse Medical, Paramount Pharmacy. They laid off all their
Sales reps. Once you are investigated by FBI for fraud you lose all your insurance contracts (imagine
That) They started another company Altius and there is no phone number listed, I am sure this is another
Scam
 








anonymous said:
As they let people go they made sure they had signed agreements that they were never allowed to engage in whistle blower suits. I thought this was a huge violation of the law but could not risk losing out on a paycheck so signed the agreement. Big mistake as they were being audited almost daily by insurance companies and the government.
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I was also a former Cordant/Sterling employee. I was also let go and was made to sign an agreement to not provide information as a whistleblower. I needed my severance and therefore signed the agreement. I do have information on the company and several clients where violations of interest to both the DOJ and FBI would be of interest. I recently filed a complaint with the OIG in hopes of putting a stop to their business practices.

I would recommend investigating Dr.Frank Kunkle in PA. As a client of Cordant, numerous kick back arrangements and business schemes were provided. Cordant has engaged in a number of highly unethical business arrangements beyond this one individual physician, including use of 1099 reps who were permitted to sell urine UDT cups to physician offices. The investors/owners are equally corrupt.
 








Well if you are a disgruntled and want ammunition: just think about every time a patients test results gets transmitted to a rep without any modifications to hide patient information & that rep brings the information into an office. . . .

HIPAA Privacy Rules for the Protection of Health and Mental Health Information
(Note: The information provided below is a summary and intended for general informational purposes. Mental health providers and other covered entities should not rely on this summary as a source of legal information or advice and should consult with their own attorney or HIPAA Privacy Officer for specific guidance.)

Introduction:

This document provides guidance about key elements of the requirements of the Health Insurance Portability and Accountability Act (HIPAA), federal legislation passed in 1996 which requires providers of health care (including mental health care) to ensure the privacy of patient records and health information. HIPAA required the federal Department of Health and Human Services (HHS) to develop regulations to implement these privacy requirements, called the Privacy Rule, which became effective on April 14, 2003. State statutes which provide more stringent protections of health care privacy remain in effect even after HIPAA, and therefore this document includes a few relevant references to requirements in New York State's mental health confidentiality statute (section 33.13 of the Mental Hygiene Law).

General:

The HIPAA Privacy Rule (45 CFR Parts 160 and 164) provides the first comprehensive Federal protection for the privacy of health and mental health information. The Rule is intended to provide strong legal protections to ensure the privacy of individual health information, without interfering with patient access to treatment, health care operations, or quality of care.

The Privacy Rule applies to “covered entities” which generally includes health plans and health care providers who transmit health information in electronic form. Covered entities include almost all health and mental health care providers, whether they are outpatient, residential or inpatient providers, as well as other persons or organizations that bill or are paid for health care.

Basic Principles of the Privacy Rule:

  1. The Privacy Rule protects all “protected health information” (PHI), including individually identifiable health or mental health information held or transmitted by a covered entity in any format, including electronic, paper, or oral statements.
  2. A major purpose of the Privacy Rule is to define and limit the circumstances under which an individual's PHI may be used or disclosed by covered entities. Generally, a covered entity may not use or disclose PHI to others, except:
    1. as the Privacy Rule permits or requires; or
    2. as authorized by the person (or personal representative) who is the subject of the health information. A HIPAA-compliant Authorization must contain specific information required by the Privacy Rules.
  3. A covered entity must provide individuals (or their personal representatives) with access to their own PHI (unless there are permitted grounds for denial), and must provide an accounting of the disclosures of their PHI to others, upon their request.
  4. The Privacy Rule supersedes State law, but State laws which provide greater privacy protections or which give individuals greater access to their own PHI remain in effect.
(Note: One must consult not only HIPAA but also other relevant federal privacy laws (such as regulations pertaining to Medicaid and federally funded substance abuse treatment programs), as well as State privacy laws (including the Mental Hygiene Law- section 33.13, the Public Health Law, the Education Law licensing provisions, and the Civil Practice Laws and Rules), to determine whether a disclosure of medical information is permissible in a given circumstance.)

Permitted Uses or Disclosures of PHI Without Authorization:

Extensive provisions of the Privacy Rule describe circumstances under which covered entities are permitted to use or disclose PHI, without the authorization of the individual who is the subject of the protected information. These purposes include, but are not limited to, the following:

  1. A covered entity may disclose PHI to the individual who is the subject of the information.
  2. A covered entity may use and disclose protected health information for its own “treatment, payment, and health care operations.”
    1. Treatment is the provision, coordination, or management of health care and related services for an individual, including consultation between providers and referral of an individual to another provider for health care.
    2. Payment includes activities of a health care provider to obtain payment or to receive reimbursement for the provision of health care to an individual.
    3. Health care operations include functions such as: (a) quality assessment and improvement; (b) competency assessment,, including performance evaluation, credentialing, and accreditation; (c) medical reviews, audits, or legal services; (d) specified insurance functions; and (e) business planning, management, and general administration.
  3. Permission may be obtained from the individual who is the subject of the information or by circumstances that clearly indicate an individual with capacity has the opportunity to object to the disclosure but does not express an objection. Providers may also rely on an individual's informal permission to disclose health information to an individual's family, relatives, close personal friends, or to other persons identified by the individual, limited to information directly related to such person's involvement.
  4. When an individual is incapacitated or in an emergency, providers sometimes may use or disclose PHI, without authorization, when it is in the best interests of the individual, as determined by health care provider in the exercise of clinical judgment. The PHIthat may be disclosed under this provision includes the patient's name, location in a health care provider's facility, and limited and general information regarding the person's condition.
  5. Providers may use and disclose PHI without a person's authorization when the use or disclosure of PHI is required by law, including State statute or court order.
  6. Providers generally may disclose PHI to State and Federal public health authorities to prevent or control disease, injury, or disability, and to government authorities authorized to receive reports of child abuse and neglect.
  7. Providers may disclose PHI to appropriate government authorities in limited circumstances regarding victims of abuse, neglect, or domestic violence.
  8. Providers may disclose PHI to health oversight agencies, (e.g., the government agency which licenses the provider), for legally authorized health oversight activities, such as audits and investigations.
  9. PHI may be disclosed in a judicial or administrative proceeding if the request is pursuant to a court order, subpoena, or other lawful process (note that "more stringent" NYS Mental Hygiene law requires a court order for disclosure of mental health information in these circumstances).
  10. Providers may generally disclose PHI to law enforcement when:
    1. Required by law, or pursuant to a court order, subpoena, or an “administrative request,” such as a subpoena or summons (Note: the "more stringent" NYS Mental Hygiene Law section 33.13 requires a court order for disclosure of mental health information in these circumstances). The information sought must be relevant and limited to the inquiry.
    2. To identify or locate a suspect, fugitive, material witness or missing person (Note: under Mental Hygiene Law section 33.13 this information is limited to “identifying data concerning hospitalization”).
    3. In response to a law enforcement request for information about a victim of a crime (Note: under Mental Hygiene Law section 33.13 this information is limited to “identifying data concerning hospitalization”).
    4. To alert law enforcement about criminal conduct on the premises of a HIPAA covered entity.
  11. Providers may disclose PHI that they believe necessary to prevent or lessen a
    1. serious and imminent physical threat to a person or the public, when such disclosure is made to someone they believe can prevent or lessen the threat (including the target of the threat).
  12. An authorization is not required to use or disclose PHI to certain government
    1. programs providing public benefits or for enrollment in government benefit
    2. programs if the sharing of information is required or expressly authorized by statute or regulation, or other limited circumstances
 
















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