Jonathan Goldfinger’s Post

The CEO, Ruthia He, and clinical president, David Brody, of telehealth startup Done. have been arrested and charged with fraud for allegedly distributing Adderall and other stimulants online. They are accused of submitting false claims and generating over $100 million in revenue by exploiting telemedicine during the COVID-19 pandemic. Federal authorities allege that they targeted drug seekers through deceptive advertisements and structured Done to facilitate easy access to stimulants without proper medical justification. Done's practices led to numerous overdoses and deaths. If convicted, He and Brody each face up to 20 years in prison. The indictment marks the first criminal drug distribution case involving telemedicine, highlighting serious concerns about the misuse of digital health platforms to prioritize profit over patient safety. Additionally, Done’s primary competitor, Cerebral., faces legal scrutiny for similar issues. Our telehealth team ensures compliance by adhering to strict medical guidelines, conducting thorough patient evaluations, using secure and transparent communication, and avoiding deceptive marketing practices. We prioritize patient safety and follow regulatory standards to prevent misuse of controlled substances, ensuring ethical and responsible telehealth services. We are the One! #revenuecycle #revenuecyclemanagement #priorauthorization #medicalbilling #medicalcoding #healthcare #healthcaretechnology #accountsreceivables #denialmanagement #consulting #management #implementationpartner Fierce Healthcare

This is precisely the kind of collusion that raises concern about the direct to consumer business model for prescription drugs. While I support the model for its increased access to therapies and patient benefits, it necessitates close monitoring, self-regulation, and government oversight. At @Capgemini, we assist customers in defining comprehensive business and data strategies, ensuring the ethical use of AI to enhance patient outcomes. Tej Sarup, Geoff McCleary, Ayan Bhattacharya #lifescience #AI4good #dataandanalytics

California based digital health company Done and its clinical president were arrested on June 13 in connection with their alleged participation in a scheme to provide easy access to prescription Adderall and other stimulants over the internet in exchange for payment of a monthly subscription fee. What’s truly alarming is that “routine medical care was discouraged by refusing to pay Done prescribers for any medical visits, telemedicine consultation, or time spent caring for patients after an initial consultation, and instead paying solely based on the number of patients who received prescriptions.” These charges are the Justice Department’s first criminal drug distribution prosecutions related to telemedicine prescribing through a digital health company. In many cases, Done prescribed ADHD medications when they were not medically necessary, exploited telemedicine’s ease of regulation during COVID, and spent millions on deceptive advertisements on social media. I still remember questioning Adderall prescriptions coming to our mail pharmacy from this company’s mid-level practitioners located all over the country. It was always difficult to reach out to any of them to validate. #healthcarefraud #controlledsubstances #pharmacy #medicine #telehealth #telemedicine #law

Fraud happens. Crime happens. I’m just surprised more digital health companies aren’t being investigated. “He and Brody are accused of instructing providers on Done Global to prescribe stimulant drugs even if the patient did not qualify, disincentivizing follow-up appointments by only paying based on the number of patients who received prescriptions, and requiring intake appointments to be under 30 minutes, the Justice Department said.” Telehealth companies (or however you want to describe them) are in a prime position to be setup for fraudulent purposes which double as a threat to public health. That’s why regulation and oversight that’s harmonised globally is so important. https://lnkd.in/ekxvG-fC

Folks, here is my HL Digest for September 16th, 2024. Make it a great week. #healthcare #kickbacks #compliance #pharmacy #doctors #DME #telemedicine #orthotic #prescriptions #dentist #dentalpatients - CA Addiction Treatment Facility Paid $2.9M to “body brokers” Casey Mahoney, 48, of Los Angeles, paid nearly $2.9 million in illegal kickbacks to "body brokers" who referred patients to his addiction treatment centers, Healing Path Detox LLC and Get Real Recovery Inc. These brokers paid patients cash, which some used to buy drugs, to induce them to attend Mahoney’s facilities. Mahoney hid the kickbacks through fake contracts with the brokers, disguising payments as fixed fees rather than being based on patient referrals. He also laundered money by making payments to one broker’s mother, falsely labeling them as consulting fees. https://bit.ly/3B40zEe - ArentFox Schiff’s Healthcare Newsletter Reports the Following Stories Several of the ArentFox Schiff #healthcare attorneys, including Jacques Smith, Randall Brater, Mike Dearington, Nadia Patel, Hillary Stemple, Roberto Martinez, and Heather Zimmer wrote a recent article of interest in the healthcare compliance space, two of which include: -Kickback Suite Against Teva Pharma Resumes -Pharma Manuf. Settles for $25M -VA Man Pleads Guilty in $1M Healthcare Fraud Scheme https://bit.ly/3XwcKRI -  Prescription Drug Kickback Scheme Disguised as “Marketing Services” According to court documents, Medoc conspirators knowingly solicited illegal kickbacks from Total RX, a Rowlett pharmacy that was struggling to stay afloat.  https://bit.ly/47qGFiV -DME Marketer Admits to Multi-Million Dollar Kickback Scheme  Vehovec and his co-conspirators sought and accepted kickbacks and bribes in return for supplying durable medical equipment (DME) companies with completed doctors' orders for DME that were medically unnecessary, such as orthotic braces. They worked with telemedicine companies to obtain these DME prescriptions, which were then fraudulently billed to Medicare and other healthcare benefit programs. https://bit.ly/4eq4kSC -CT Dentists Involved in Medicaid Patient Kickback Scheme Rivkin Radler LLP healthcare attorney Sean Simensky wrote an excellent summary of a kickback case involving three dentists and Medicaid patients.  The government alleged that from 2016 to 2018, the dental practices paid a recruiter $115 for each Connecticut Medicaid patient referred to them. https://bit.ly/3B3oVxL

Folks, here is my HL Digest for September 16th, 2024. Make it a great week. #healthcare #kickbacks #compliance #pharmacy #doctors #DME #telemedicine #orthotic #prescriptions #dentist #dentalpatients - CA Addiction Treatment Facility Paid $2.9M to “body brokers” Casey Mahoney, 48, of Los Angeles, paid nearly $2.9 million in illegal kickbacks to "body brokers" who referred patients to his addiction treatment centers, Healing Path Detox LLC and Get Real Recovery Inc. These brokers paid patients cash, which some used to buy drugs, to induce them to attend Mahoney’s facilities. Mahoney hid the kickbacks through fake contracts with the brokers, disguising payments as fixed fees rather than being based on patient referrals. He also laundered money by making payments to one broker’s mother, falsely labeling them as consulting fees. Link: https://bit.ly/3B40zEe - ArentFox Schiff’s Healthcare Newsletter Reports the Following StoriesSeveral of the ArentFox Schiff healthcare attorneys, including Jacques Smith, Randall Brater, Mike Dearington, Nadia Patel, Hillary Stemple, Roberto Martinez, and Heather Zimmer wrote a recent article of interest in the healthcare compliance space, two of which include: -Kickback Suite Against Teva Pharma Resumes -Pharma Manuf. Settles for $25M -VA Man Pleads Guilty in $1M Healthcare Fraud Scheme Link: https://bit.ly/3XwcKRI - Prescription Drug Kickback Scheme Disguised as “Marketing Services” According to court documents, Medoc conspirators knowingly solicited illegal kickbacks from Total RX, a Rowlett pharmacy struggling to stay afloat. Link: https://bit.ly/47qGFiV - DME Marketer Admits to Multi-Million Dollar Kickback Scheme Vehovec and his co-conspirators sought and accepted kickbacks and bribes in return for supplying durable medical equipment (DME) companies with completed doctors' orders for DME that were medically unnecessary, such as orthotic braces. They worked with telemedicine companies to obtain these DME prescriptions, which were then fraudulently billed to Medicare and other healthcare benefit programs. Link: https://bit.ly/4eq4kSC - CT Dentists Involved in Medicaid Patient Kickback Scheme Rivkin Radler LLP healthcare attorney Sean Simensky wrote an excellent summary of a kickback case involving three dentists and Medicaid patients.  The government alleged that from 2016 to 2018, the dental practices paid a recruiter $115 for each Connecticut Medicaid patient referred to them. Link: https://bit.ly/3B3oVxL

Are you sure those consultants are helping to improve your business? Or are they potentially sending you to jail? #ancillaries #ancillary #ASC #business #care #code #coding #compliance #comply #consultant #crime #criminal #doctor #facility #fair #fine #fmv #group #health #healthcare #hospital #jail #market #McKinsey #medical #opioid #penalty #physician #prison #risk #value

Drug diversion is a critical issue affecting hospitals, EMS, Fire Departments, pharmacies, and nursing care facilities across the United States. With an estimated $73 billion linked to drug diversion annually, the financial costs are staggering, but the human toll is immeasurable—loss of lives, severe addictions, incarcerations, department shutdowns, massive fines to businesses, and ruined careers. Co-written with James Squibbs, Senior Account Executive, this week's IntelliView blog explores: • Understanding Drug Diversion: What it is and why it’s a pressing issue. • Consequences of Drug Diversion: The profound impact beyond financial losses. • Common Methods of Drug Diversion: How it happens and why it's challenging to manage. • Effective Management Strategies with IntelliView: Leveraging advanced solutions to mitigate risks. Don't miss out on this insightful read—check out the full blog here: https://lnkd.in/eB_HSrhu #DrugDiversion #HealthcareSafety #ControlledSubstances

The Rolling Stones offer drug death prevention advice. https://lnkd.in/e6rWrVnK After a teen died, a Home Office spokesperson said the government was "deeply concerned" about the impact of illicit drugs on communities: “We will continue our engagement with partners across health, policing and wider public services to drive down drug misuse, tackle the criminals behind the drug trade, and move forward with our mission to make streets safer." That’s it? This Home Office policy statement doesn’t contain one new idea — really one idea of any sort. It’s just a sea of platitudes: “deeply concerned,” “engagement with partners,” “drive down drug misuse,” “tackle the dealer criminals,” “make streets safer." Do you feel they already had this stored in a Google doc labeled “Press Release Next Adolescent Death”? Let’s see — whom can we ask? When were Mick and Keith jailed? 1967. That was 57 years ago, when they were in their early 20s. The Rolling Stones, making a triumphant return with the release of their critically acclaimed album, 'Hackney Diamonds,' announced a string of shows in the United States in 2024. Mick Jagger turned 81 in July, Keith Richards will be 81 in December. Perhaps we should ask the boys rather than the Home Secretary about drug use survival. I didn’t have time to contact the Stones, however. So I’ll fill in the answers: “It sort of doesn’t matter what drugs you take, young or old. You really need to develop a set of skills, a life purpose to pursue with a like-minded group. There will be ups and downs for sure. Try to keep an even keel — even should you be jailed. It certainly helps to have good assistance. In our case it was more legal than medical at the time. But there’s a lot to argue in favor of staying out of prison, being concerned to be able to continue working. That includes staying alive.” They apologized to me for not having anything more brilliant to say. “We’re only f’in musicians. We barely went to school. And, let’s face it, we took a lot of drugs.” “Still,” they added. “It’s a lot better than what the f’in Home Office has to say.” “And they’ve had the same 57 years to think up a better answer that we’ve had.”

The World Has Changed—#340b Needs to Change with It When 340B was passed … • co-insurance costs weren’t at ridiculously high percentages, costing patients thousands of dollars—now 340B, as 46brooklyn Research says, is a program that “makes money off the backs of sick people” through exorbitant “cost-sharing”; • there was no #PartD program, so #Medicare didn’t cover those drugs at all, and didn’t, therefore, pay huge “spreads” on deeply discounted drugs; • roughly 200 hospitals were thought to be likely participants—now more than 2,600 are, including some that are part of institutions with endowments that exceed $40 billion; • Medicare paid hospitals for their outpatient services at their costs—now it pays 340B hospitals a huge spread (as high as 145% or more) according to MedPAC; • national pharmacies connected to dominant PBMs that are affiliates of dominant payers didn’t exist—now they suck billions out of the program; • roughly 250 million had health insurance—now more than 300 million do; and • the program was an incidental appendage of what was intended to be a massively larger Medicaid rebate program—now the 340B program is LARGER than the #MDRP and getting larger every day. The world has changed, and 340B needs to change with it. #pricereporting #aca #pharmacy #pharmacists #specialtypharmacy #patientsfirst #access #partbdrugs #medPAC #copays #costsharing #charitycare #funancialneed #financialtoxicity