Hospitals that participate in the 340B program may be entitled to additional monies from Medicare Advantage plans in the wake of the Supreme Court’s decision in AHA v. Becerra.
In AHA v. Becerra, a unanimous Supreme Court...more
On January 9, 2020, DOJ announced it recovered more than $3 billion in settlements and judgments from civil cases involving fraud and false claims against the government in the fiscal year ending September 30, 2019. DOJ...more
1/17/2020
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Department of Justice (DOJ) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
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Physicians ,
Qui Tam
On September 20, 2018, CMS published a proposed rule that the agency states is aimed at reducing the regulatory burden for providers by revising certain aspects of the Medicare Conditions of Participation and Conditions of...more
On June 22, 2018, the United States District Court for the Central District of California denied Humana’s motion to dismiss a suit brought by a large nationwide hospital system, Prime Healthcare Services (Prime). In a...more
On April 23, 2018, CMS released CMS-1727-R (the Ruling), which announced that it will follow the United States District Court’s decision in Banner Heart Hospital v. Burwell, 201 F. Supp. 3d 131 (D.D.C. 2016). The Banner...more
On December 29, 2017, OIG issued a favorable advisory opinion interpreting the application of the gainsharing civil monetary penalty provision (Gainsharing CMP) and the Anti-Kickback Statute in connection with a proposed...more
On December 4, 2017, the DOJ announced a $7.5 million settlement with Pine Creek Medical Center, a Dallas-based physician-owned hospital. The settlement resolves allegations that the hospital paid physicians kickbacks in the...more
On September 6, 2017, CMS’s Center for Clinical Standards and Quality/Survey & Certification Group announced revisions to Appendix A of the State Operations Manual (SOM), which governs hospital surveys. The revisions are...more
On July 6, 2016, CMS released the Calendar Year (CY) 2017 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule. In addition to significant proposals...more