The Department of Health and Human Services has released extensive and significant revised final rules governing the Physician Self-Referral Law (the Stark law) and the Medicare Anti-Kickback Statute (AKS) in furtherance of...more
12/21/2020
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Patients ,
Payment Systems ,
Physicians ,
Safe Harbors ,
Self-Referral ,
Stark Law ,
Value-Based Care
This week the Department of Justice reported it recovered $3 billion from False Claims Act cases in 2019. Of that recovery amount, $2.1 billion resulted from whistleblower, or qui tam, actions. In addition, 633 new qui tam...more
1/27/2020
/ Civil Monetary Penalty ,
Department of Justice (DOJ) ,
Disgorgement ,
Enforcement Actions ,
False Claims Act (FCA) ,
Health Care Providers ,
Medicaid ,
Medicare ,
Pharmaceutical Industry ,
Qui Tam ,
Settlement Agreements ,
State Medicaid Programs ,
Whistleblowers
The OIG updates its Work Plan monthly to identify audits and evaluations that are underway or proposed by the OIG's Office of Audit Services and Office of Evaluation and Inspections. The October 2019 update identifies new...more
11/19/2019
/ Audits ,
Drug Testing ,
Health Care Providers ,
Hospice ,
Medical Devices ,
Medicare ,
Medicare Part B ,
OIG ,
Provider Payments ,
Suppliers ,
Work Plans
A new federal court decision offers a ray of light to those providers defending false claims actions based on an alleged lack of medical necessity. On September 9, 2019, the United States Court of Appeals for the Eleventh...more
9/13/2019
/ Appeals ,
Bifurcation ,
Defense Strategies ,
Department of Justice (DOJ) ,
Expert Witness ,
False Claims Act (FCA) ,
Federal Contractors ,
Health Care Providers ,
Healthcare Fraud ,
Hospice ,
Interrogatories ,
Judgment Notwithstanding the Verdict (JNOV) ,
Jury Verdicts ,
Medical Necessity ,
Medicare ,
Physicians ,
Reaffirmation ,
Remand ,
Set-Asides
The U.S. Department of Health and Human Services, Office of Inspector General (OIG), recently published its Spring 2019 Semiannual Report to Congress. The report, released June 3, 2019, covers the period October 1, 2018...more
6/24/2019
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Congressional Reports ,
Criminal Prosecution ,
Cybersecurity ,
Department of Health and Human Services (HHS) ,
Exclusion Orders ,
Federal Grants ,
Health Care Providers ,
Healthcare Fraud ,
Home Health Care ,
Information Reports ,
Off-Label Use ,
OIG ,
Opioid ,
Prescription Drugs ,
Provider Payments ,
Public Contracts ,
Quality of Care Standards ,
Refugees
The U.S. Justice Department has updated its "Evaluation of Corporate Compliance Programs," a guidance document detailing topics and questions prosecutors should weigh when determining whether a company has demonstrated...more
5/29/2019
/ Ambulatory Surgery Centers ,
Board of Directors ,
Compliance ,
Corporate Executives ,
Corporate Misconduct ,
Criminal Investigations ,
Department of Justice (DOJ) ,
Disciplinary Proceedings ,
Ethics ,
Government Investigations ,
Health Care Providers ,
Hospitals ,
Internal Audit Functions ,
Internal Investigations ,
Long Term Care Facilities ,
Nursing Homes ,
Physicians ,
Tone At The Top
Recent congressional action will have serious ramifications on corporate and individual defendants who are or could be under investigation for violations of federal health care program fraud and abuse laws. Changes...more
3/28/2018
/ Anti-Kickback Statute ,
Bipartisan Budget Act ,
Civil Monetary Penalty ,
Criminal Penalties ,
Criminal Prosecution ,
Deductible Expenses ,
Federal Health Care Programs (FHCP) ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare Fraud ,
New Legislation ,
Qui Tam ,
Settlement ,
Tax Cuts and Jobs Act
The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) published two rules on December 7, 2016, updating certain existing safe harbor regulations, adding new safe harbor rules under...more
12/16/2016
/ Civil Monetary Penalty ,
Department of Health and Human Services (HHS) ,
FQHC ,
Health Care Providers ,
Medicare ,
Medicare Advantage Organizations (MAOs) ,
Medicare Part B ,
OIG ,
Pharmacies ,
Remuneration ,
Rural Areas ,
Safe Harbors