The recent sentencing of a former Michigan pharmacist to nearly four years in prison for orchestrating a $4 million Medicare fraud scheme underscores a persistent vulnerability in pharmacy operations: the gap between inventory systems and claims processing. Between 2011 and 2017, Nabil Fakih, owner of a Dearborn Heights pharmacy, submitted claims to Medicare for high-cost medications, such as blood thinners and inhalers, that were never dispensed, and in many cases, never even stocked.

The recent $45 million settlement between the U.S. Department of Justice and Vohra Wound Physicians marks more than a punitive action. It also surfaces a structural weakness in healthcare billing that leaders can no longer afford to overlook. Vohra, one of the largest providers of bedside wound care in skilled nursing facilities, was accused of engineering an internal system that used electronic health records (EHRs) and billing automation to systematically overcharge Medicare for unnecessary and sometimes unperformed surgical debridement procedures.

The recent guilty pleas of three former executives from Primary Health Network, one of Pennsylvania’s largest community health organizations, mark more than the end of a multi-year criminal conspiracy.

A new nationwide analysis of Bell’s palsy management patterns reveals a costly disconnect between clinical guidelines and frontline practice. The study, led by researchers at Mount Sinai Health System and published in The Laryngoscope, finds that nearly one in four patients with Bell’s palsy receives advanced imaging, despite clear recommendations discouraging routine use.