Darby C. Allen

Darby C. Allen

BakerHostetler

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Proposed Rule Aims to Refine Stark Regulations and Clarify “Incident To”

On July 15, 2015, the Centers for Medicare and Medicaid Services (CMS) published the calendar year (CY) 2016 Physician Fee Schedule Proposed Rule. In addition to updating several traditional Part B payment policies, the...more

7/28/2015 - Affordable Care Act CLIA CMS Compliance FQHC Healthcare Hospitals Medicaid Medicare Medicare Part B Physician Fee Schedule Physicians Rural Health Care Providers Self-Referral Stark Law Tuomey

Tuomey Judgment Upheld in Novel Stark Law and False Claims Act Case

The U.S. Court of Appeals for the Fourth Circuit recently upheld the judgment against Tuomey Healthcare System, Inc. (Tuomey), in a qui tam False Claims Act case predicated on Stark Law violations. The district court in the...more

7/20/2015 - Appeals Eighth Amendment Employment Contract False Billing False Claims Act Fifth Amendment Healthcare Physician Compensation Arrangements Qui Tam Stark Law

Providers Get Rare Win in New Texas Law Protecting Out-of-Network Referrals

On June 1, 2015, Texas Governor Greg Abbott signed House Bill 574 into law protecting physicians and other providers from having their participating provider agreements terminated by an insurer solely because the provider’s...more

7/13/2015 - CHIP Covered Providers Health Insurance Healthcare Healthcare Providers Medicaid Out of Network Provider Physicians

OIG Fraud Alert Cautions Against Sham Medical Director Arrangements

The HHS OIG recently issued a brief fraud alert (Fraud Alert) reminding physicians that inappropriate compensation arrangements may lead to enforcement actions under the federal anti-kickback statute and Civil Monetary...more

6/25/2015 - Anti-Kickback Statute CMP Law Healthcare HHS Hospitals Medical Directors OIG Patient Referrals Physician Compensation Arrangements Risk Alert Stark Law

Supreme Court Decision Has Good News and Bad News for Those Facing False Claims Act Litigation

On May 26, 2015, the Supreme Court of the United States (SCOTUS) issued an opinion in a federal False Claims Act (FCA) case that resolves two important procedural points litigants face: the tolling of the six-year statute of...more

6/1/2015 - False Claims Act First-to-File Health Care Providers Healthcare KBR (formerly Kellogg Brown & Root) Popular Qui Tam SCOTUS Statute of Limitations Whistleblowers WSLA

Aetna Out of Patience With Hospital’s Alleged Out-of-Network Billing Scheme

Aetna Life Insurance Company (Aetna) is going on the offensive against a Northwest Houston hospital with an out-of-network strategy. On February 23, 2015, Aetna filed suit in Texas federal court against Robert A. Behar, M.D....more

3/3/2015 - Aetna Excessive Fees Hospitals Insurance Litigation Out of Network Provider

OIG Advisory Opinion Sheds Light on Preventive Care Exception

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently issued an advisory opinion approving an arrangement whereby a licensed entity providing services under a state program for...more

2/17/2015 - Advisory Opinions Anti-Kickback Statute Healthcare HHS Medicaid OIG Preventive Health Care

Breaking News: CMS Delays Final Overpayment Rule

Today, the Centers for Medicare and Medicaid Services (CMS) announced that it is extending the deadline to finalize the rule implementing the Affordable Care Act provision that requires providers to timely report and return...more

2/16/2015 - Affordable Care Act CMS Health Care Providers Medicare Overpayment

OIG Proposed Anti-Kickback Safe Harbors and CMP Regulations: The End of Frustration or Just the Beginning?

On October 3, 2014, the U.S. Department of Health and Human Services Office of Inspector General (OIG) published an unexpected, yet long-awaited, set of proposed rules that would add new anti-kickback law safe harbors,...more

10/17/2014 - Affordable Care Act Ambulance Providers Anti-Kickback Statute CMP Law Gainsharing Healthcare Medicaid Medicare Medicare Part D OIG Pharmacies Proposed Regulation Safe Harbors

Summer Fraud and Abuse Roundup

The federal government was busy over the summer when it came to decisions and settlements under the Stark Law, anti-kickback law and federal False Claims Act. This article revisits recent developments with respect to...more

8/25/2014 - Anti-Kickback Statute False Claims Act Fraud and Abuse Healthcare Healthcare Fraud Settlement Stark Law Whistleblowers

OIG Revamps Regulations Concerning CMPs and Exclusion

In a pair of proposed rules published in May, the HHS OIG unveiled changes to the regulations concerning OIG’s authority to impose civil monetary penalties (CMPs) and exclude individuals and entities from participation in...more

6/3/2014 - Affordable Care Act Civil Monetary Penalty Employee Benefits Enforcement Exclusions Fraud and Abuse Healthcare OIG

Stark Law Update: All Children’s Settles False Claims Act Allegations

All Children’s Health System (ACHS) will pay the federal government and state of Florida $7 million to settle allegations that it violated the federal and Florida False Claims Act statutes by submitting claims to Medicaid...more

5/7/2014 - False Claims Act Medicaid Stark Law Whistleblowers

Halifax Reportedly Settles Landmark Stark Case

According to minutes filed in the U.S. District Court for the Middle District of Florida, Halifax Hospital Medical Center (Halifax) and the U.S. Department of Justice (DOJ) have reached a settlement in the pending False...more

3/11/2014 - DOJ False Claims Act Healthcare Healthcare Professionals Hospitals Physicians Stark Law

OIG and CMS Extend Expiration Date for EHR Donations

As the final days of 2013 passed and the sunset of the Stark Law exception and anti-kickback law safe harbor for electronic health record (EHR) donations loomed nearer, the U.S. Department of Health and Human Services (HHS)...more

1/30/2014 - CMS Data Protection Deadlines EHR Healthcare OIG PHI

Federal Judge Dismisses All Anti-Kickback Claims in Halifax Hospital Medical Center Case

On January 8, 2014, the U.S. district judge in the Halifax Hospital Medical Center (Hospital) case pending in the Middle District of Florida granted the Hospital's motion to dismiss all of the relator's anti-kickback law...more

1/29/2014 - Anti-Kickback Statute False Claims Act Florida Healthcare Fraud Hospitals Kickbacks Relators Stark Law

Feds Win Crucial Motions in Two High-Stakes Stark Cases

On the heels of the landmark Tuomey case (see the October 3, 2013 issue of the Health Law Update), the federal government recently has seen success in two more False Claims Act cases predicated on alleged Stark Law...more

12/16/2013 - False Claims Act Healthcare Hospitals Physicians Stark Law

Two for Me; Many Times More for the Government in the Largest Whistleblower Award Against a Community Hospital

A U.S. district judge in South Carolina approved the government's request for a civil penalty award and ordered Tuomey Healthcare System, Inc. (Tuomey) to pay more than $237 million in damages and fines in a whistleblower...more

10/7/2013 - FCA Healthcare Professionals Hospitals Medical Liability Stark Law Whistleblowers

2014 Physician Fee Schedule: Cuts and Quality and Data! Oh My!

The Centers for Medicare and Medicaid Services (CMS) recently released the calendar year 2014 Physician Fee Schedule Proposed Rule (Proposed Rule)....more

8/12/2013 - Affordable Care Act CMS Healthcare Hospitals Physician Fee Schedule Physician SGR Formula Physicians Reimbursements

Hospital Ordered to Produce Privileged Documents Under the Crime-Fraud Exception

A magistrate judge in the U.S. District Court for the Middle District of Florida recently ordered a hospital defendant in a False Claims Act (FCA) case to turn over two prime documents to the U.S. Department of Justice and...more

5/31/2013 - Attorney-Client Privilege Crime-Fraud Exception DOJ False Claims Act Hospitals Whistleblowers

Groundhog Day for Tuomey: Jury Finds Hospital Violated Stark Law and False Claims Act

On May 8, 2013, a jury in the Columbia Division of the U.S. District Court for the District of South Carolina returned a verdict finding that Tuomey Healthcare Systems, Inc. (Tuomey) violated the Stark Law and the federal...more

5/22/2013 - False Claims Act Healthcare Hospitals Medicare Physicians Stark Law Whistleblowers

Novel “Bad Faith Admission” EMTALA Theory Survives Motion to Dismiss

The U.S. District Court for the Northern District of California recently denied Contra Costa Regional Medical Center’s (CCRMC) motion to dismiss regarding an alleged violation of the Emergency Medical Treatment and Labor Act...more

5/3/2013 - EMTALA Liability Motion to Dismiss

Sixth Circuit Holds Physician Supervision and Enrollment Issues Are Not Conditions of Payment for Purposes of FCA Liability

The Sixth Circuit Court of Appeals recently issued a decision overturning an $11.1 million False Claims Act (FCA) verdict against MedQuest Associates, Inc. (MedQuest) for submitting claims to Medicare in violation of the...more

4/23/2013 - False Claims Act Medicare MedQuest Physician Payments Physicians Supervision

OIG and CMS Issue Proposals to Extend Safe Harbor and Exception for EHR Donations

In the April 10 Federal Register, two agencies within the U.S. Department of Health and Human Services published proposed rules that many healthcare providers have been anxiously awaiting affecting donations of electronic...more

4/22/2013 - Anti-Kickback Statute CMS Electronic Medical Records Healthcare Medical Devices OIG Physicians Safe Harbors Stark Law

OIG Issues Special Fraud Alert for Physician-Owned Entities

The U.S. Department of Health and Human Services Office of Inspector General (OIG) recently issued a Special Fraud Alert expressing concern that physician-owned entities "that derive revenue from selling, or arranging for the...more

4/5/2013 - Anti-Kickback Statute Fraud HHS Medical Devices Physician-Owned Distributors Physicians

CMS Addresses Hospital Rebilling After Inpatient Denials Through Interim Administrator Ruling and Proposed Rule

On March 18, the Centers for Medicare and Medicaid Services (CMS) published in the Federal Register two important documents addressing the hotly contested issue of a hospital's ability to obtain payment under Part B for...more

3/22/2013 - Billing CMS Denial of Benefits Healthcare Hospitals Medicare

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