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 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
In its Work Plan for Fiscal Year 2012, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) announced it would begin reviews of Medicare payments to hospitals to determine compliance...more
10/27/2015
/ Administrative Law Judge (ALJ) ,
Audits ,
Compliance ,
Department of Health and Human Services (HHS) ,
Healthcare ,
Hospitals ,
Inpatient Billing ,
Medical Devices ,
Medicare ,
Medicare Payment Reform ,
OIG ,
Overpayment
After reading through the hundreds of pages of the District Court's and Appeals Court's decisions, including the recent Fourth Circuit Court of Appeals decision that was filed on July 2, 2015, one thing is certain: Mixing one...more
7/15/2015
/ Agency Agreement ,
Appeals ,
Compliance ,
Employment Contract ,
False Claims Act (FCA) ,
Healthcare ,
Hospitals ,
Medicare ,
Patient Referrals ,
Physicians ,
Self-Referral Disclosure Protocol ,
Stark Law