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A Cautionary Tale for Companies With Potential False Claims Act Exposure

A False Claims Act suit can be a company’s worst nightmare, as it may potentially result in large settlements and awards on account of the statute’s trebled damages provision. However, the nightmare for AmerisourceBergen was...more

HealthCare Fraud and Courtesies: What to Know Before Waiving a Copayment

Many healthcare facilities and physicians waive the insurance copayment for physicians and their families (known as professional courtesy) or other patients. Yet, despite how prevalent the practice is and the limited...more

OIG Issues Proposed Rules on Its Exclusion and CMP Authorities

OIG has issued two proposed rules that would expand the agency’s ability to impose certain sanctions on entities and individuals involved with Federal health care programs. OIG’s first proposed rule—published in the Federal...more

OFCCP Setting Its Sites On TRICARE Providers?

Healthcare providers are waiting anxiously to see the Office of Federal Contract Compliance Programs’ (OFCCP) most recent position on whether it will continue trying to assert jurisdiction over them on the basis of...more

Florida’s False Claims Act – Did You Know It Changed Last Year?

In June 2013, Florida’s legislature significantly amended Florida’s False Claims Act, Fla. Stat. §§ 68.081-68.092 (“FFCA”), effective July 1, 2013. Although these amendments have not received much publicity or commentary,...more

People ex rel. Farmers Insurance Exchange, et al v. Maurice Hale, M.D., et al

People ex rel. Farmers Insurance Exchange, et al v. Maurice Hale, M.D., et al, case No. BC515676 (California Superior Court, County of Los Angeles; filed July 18, 2013)...more

U.S. District Court Finds Halifax Hospital Violated the Stark Law in Summary Judgment

A United States District Court in the Middle District of Florida recently granted partial summary judgment in favor of the United States in connection with its motion against Halifax Hospital Medical Center (Halifax...more

Eighth Circuit Adopts Novel False Claims Act Fraud-in-the-Inducement Theory Long Espoused by Government

On October 15, 2013, a divided three-judge panel of the United States Court of Appeals for the Eighth Circuit rendered a federal False Claims Act ("FCA") judgment against Bayer Healthcare Pharmaceuticals ("Bayer"), based on a...more

GAO Examines Effectiveness of Health Care Fraud and Abuse Control Program Activities

The U.S. Government Accountability Office (GAO) recently published a report analyzing the effectiveness of Health Care Fraud and Abuse Control (HCFAC) program activities titled, “Indicators Provide Information on Program...more

Second Circuit Affirms Dismissal of Qui Tam Case Based on Attorney’s Use of Confidential Information

The US Court of Appeals for the Second Circuit recently affirmed the decision of the District Court for the Southern District of New York to disqualify Fair Laboratory Practices Associates (FLPA) from its qui tam suit against...more

California Insurance Commissioner Announces Settlement with Sutter Hospitals Over False Claims Allegations

Insurance Commissioner Dave Jones announced yesterday that Sutter Health, which operates over 20 hospitals in northern California, agreed to pay $46 million and change its billing and disclosure of anesthesia charges and...more

McKesson settles with Virginia for $37 million over allegations of inflating Medicaid drug prices

After the State of Virginia declined to participate in a July 2012 settlement that McKesson reached with 29 states over allegations of federal and various state False Claims Act violations, the company has agreed to pay...more

Doc Wishes He Showed Up at the Office — But . . .

Imagimed LLC, an MRI Center, its owners and chief radiologist, agreed to pay the government $3.57 million to settle false claims allegations for MRI services. The government alleged that Imagimed billed for MRI scans...more

Will Usual and Customary Price be the Next False Claims Act Battleground?

Recently, a federal judge held that a qui tam relator’s allegations that a pharmacy routinely reported falsely inflated “usual and customary” prices for generic medications in claims submitted to federally funded health care...more

GAO Report on Medicare Contractors

On August 22, the U.S. Government Accountability Office (GAO) released a report calling for the Centers for Medicare & Medicaid Services (CMS) to improve the efficiency and effectiveness of its Medicare program integrity...more

GAO Calls For Consistency Among Medicare Contractors Postpayment Claims Review

The U.S. Government Accountability Office (GAO) recently published the results of a study examining the effectiveness of CMS’s contractors that conduct postpayment claims reviews to identify improper payments (i.e., Medicare...more

Legislation Introduced in the House Would Amend the False Claims Act

On August 1, 2013, Reps. Howard Coble (R-N.C.) and David Scott (D-Ga.) introduced bipartisan legislation in the House that would amend the federal False Claims Act (FCA) by adding several procedural hurdles that make it more...more

ARB Issues Reconsideration Decision in OFCCP v. Florida Hospital of Orlando

On July 22, 2013, the Administrative Review Board (ARB) of the Department of Labor (DOL) held that a network participation agreement entered into by Florida Hospital with Humana Military Health Services (HMHS) for the...more

Health Insurer Settles OFCCP Retaliation Allegations for $372,000

A health insurance provider in Massachusetts has agreed to pay $372,739 to resolve an Office of Federal Contract Compliance Programs (OFCCP) investigation into claims of discrimination and retaliation....more

OIG Publishes Audit of Outpatient Therapy Services Seeking Return of $3.1 Million in Reimbursements

In June 2013, the Department of Health and Human Services, Office of Investigator General (OIG) published a review of its audit of an outpatient therapy services provider. The OIG concluded that the outpatient therapy...more

Court of Appeals Hands Down Significant DSH Ruling

As we reported in a Payment Matters article dated February 16, 2012, early last year the United States District Court for the District of Columbia handed providers a significant victory in Catholic Health Initiatives-Iowa v....more

Texas Makes Changes to Medicaid Laws and Programs

Texas Governor Rick Perry signed a series of bills into law last week modifying some of the state’s Medicaid statutes and programs. The laws will take effect on September 1, 2013....more

Updated OIG Exclusion Guidance Spells Out Recommended Employee Screening Procedures

On May 8, 2013, the Office of Inspector General (OIG) published an updated bulletin that spells out the frequency with which employers should check the OIG’s List of Excluded Individuals and Entities and clarifies which...more

PRIME Act: New Legislation to Curb Health Care Fraud

The United States Senate and House of Representatives recently introduced bipartisan legislation designed to reduce fraud, waste, and abuse in the Medicare and Medicaid programs. The legislation, entitled “Preventing and...more

2013 Healthcare Fraud and Abuse Bootcamp Webinar Series, Part V: Compliance

Bill Mathias of Ober|Kaler's Health Law Group presented on compliance as a part of the 2013 Healthcare Fraud and Abuse Bootcamp Webinar Series sponsored by the American Health Lawyers Association. This webinar...more

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