Darby C. Allen

Darby C. Allen

BakerHostetler

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Escobar Oral Arguments: Justices Imply Outcome – False Claims Act Implied Certification May Survive

The U.S. Supreme Court recently held oral arguments in the case of Universal Health Services, Inc. v. U.S. ex rel. Escobar, No. 15-7, which is set to decide the viability of implied certification under the FCA. As discussed...more

5/10/2016 - False Claims Act (FCA) False Implied Certification Theory Implied Certification SCOTUS Universal Health Services Inc v United States ex rel Escobar Whistleblowers

Caution: False Claims Act Penalties Poised to Double

A preview of the effects that a provision in the Bipartisan Budget Act of 2015 will have on healthcare providers came to light this week when the Railroad Retirement Board (Board) published an interim final rule implementing...more

5/9/2016 - Bipartisan Budget DOJ False Claims Act (FCA) Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015 Healthcare

The Deeper Dive: The Final Overpayment Rule

The Centers for Medicare and Medicaid Services (CMS) recently issued its final rule for Reporting and Returning of Overpayments (Final Rule). The Final Rule implements section 1128J(d) of the Social Security Act, which...more

2/26/2016 - 60-Day Rule CMS False Claims Act (FCA) Final Rules Health Care Providers Medicare Part A Medicare Part B Overpayment Recovery Time Limits Reporting Requirements Stark Law

Breaking News: 60-Day Overpayment Rule Finalized

The Centers for Medicare and Medicaid Services (CMS) released its final rule implementing Section 6402(a) of the Affordable Care Act that requires Medicare providers and suppliers to report and return overpayments within 60...more

2/12/2016 - 60-Day Rule Affordable Care Act CMS False Claims Act (FCA) Health Care Providers HHS Medicare Overpayment Recovery Time Limits

CMS Finalizes Revisions to Stark to Ease Burden on Providers, Refines “Incident to” Requirements

In its calendar year 2016 Physician Fee Schedule Final Rule published in the Federal Register on November 16, 2015 (Final Rule), the Centers for Medicare and Medicaid Services (CMS) finalized amendments to the federal...more

11/23/2015 - CMS Final Rules Healthcare Medicare Payment Reform Stark Law

DOJ Takes Aim at Responsible Individuals in Corporate Investigations

U.S. Deputy Attorney General Sally Quillian Yates recently announced new instructions for attorneys at the U.S. Department of Justice (DOJ), outlining in a memorandum the DOJ’s policies with respect to civil and criminal...more

10/12/2015 - Best Practices Corporate Investigations DOJ Enforcement Actions False Claims Act (FCA) Federal Prosecutors Health Care Providers Healthcare Misappropriation Professional Misconduct Yates Memorandum

Texas Hospital Strikes Back at Aetna

On February 23, 2015, Aetna filed suit in Texas federal court against Robert A. Behar, M.D. and North Cypress Medical Center (North Cypress), alleging that Dr. Behar, the CEO of North Cypress, offered impermissible ownership...more

8/31/2015 - Aetna Breach of Duty Contingency Fees ERISA Fiduciary Duty Healthcare Healthcare Fraud Hospitals Insurance Industry Lanham Act Life Insurance Malicious Prosecution Out of Network Provider Patient Referrals Real Party in Interest RICO Tortious Interference

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 (FCA) 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 Care Providers Health Insurance Healthcare 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 (FCA) 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 (FCA) 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 (FCA) 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 (FCA) Health Care Providers Healthcare 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 (FCA) 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 (FCA) 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 - Financial Conduct Authority (FCA) Health Care Providers 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

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