Health Government Contracting

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Healthcare Compliance Programs to Avoid a False Claims Act Case

You can always count on lawyers to ring alarm belles and warn businesses. The line between accurate reporting and fear-mongering sometimes blurs when lawyers write so-called “alerts” to inform businesses of new or increasing...more

Watch Out! Recent Government Settlements Implicate Referring Physicians and Laboratories

$48.5 million settlement with Health Diagnostics Laboratory, Inc. and Singulex, Inc. - On April 9, 2015, the U.S. Department of Justice ("DOJ") announced a $48.5 million settlement with two cardiovascular diagnostic...more

Time to Exclude the IMD Exclusion

Some rules are borne out of the best of intentions, and the Institutions for Mental Disease Exclusion (“IMD exclusion”) bears the hallmarks of such a beginning. The IMD exclusion bars federal funding for care of patients...more

Blog: Senator Grassley Requests Information Related to Potential Medicare Advantage Fraud

Senator Grassley issued letters this week to the Centers for Medicare and Medicaid Services (CMS) and Department of Justice (DOJ) related to potential fraud in the Medicare Advantage program. Citing news articles, DOJ...more

Physicians as whistleblowers: Doctors get rich by exposing fraud

As the federal and state governments have evolved from Uncle Sam to Doctor Sam, the potential for healthcare waste, fraud and abuse has also increased. One way the government has deterred healthcare fraud is by enacting and...more

Managing Institutional Risk: Fraud-Proofing Your Organization

In this presentation: - Top 5 Fraud and Abuse Risks Facing Health Systems - Results of Enforcement Action - Top 5 Steps Health Systems Can Take To Minimize Fraud & Abuse Risk - Non-Compliant...more

Out of the Mouths of Babes: Millions of Medicaid Dollars

Last Monday the Office of Inspector General of Health & Human Services posted a hair-raising report. “Questionable Billing for Medicaid Pediatric Services in California” raises alarming questions about the billing practices...more

The Sixth Circuit Reins in the Government's Measure of False Claims Act Damages

Pharmaceutical and device companies, financial institutions, government contractors, oil and gas conglomerates, and other public and private entities continue to be in the crosshairs of aggressive federal government...more

Healthcare Fraud Initiatives in 2015

In order to predict what 2015 will look like in the war against health care fraud, it is necessary to quickly review what happened in 2014. In 2014, the government’s health care fraud prevention and enforcement efforts...more

DOJ Pursuing Therapy Providers Under the FCA

As most recently spotlighted by the Department of Justice’s intervention in whistleblower claims against ManorCare, DOJ is increasing its enforcement of the False Claims Act (FCA) against therapy providers. In particular, DOJ...more

State May Not Disclose Trade Secrets Submitted as Part of RFP Response

If you have ever agonized about whether to include certain confidential business information in a bid for a state contract in New Hampshire because of concerns that your competitors might get their hands on it, you should...more

RAC Reform Legislation Reintroduced in House

On April 30, 2015, Representatives Sam Graves (R-MO) and Adam Schiff (D-CA) reintroduced H.R. 2156, the Medicare Audit Improvement Act of 2015. H.R. 2156 contains a number of significant new provisions from legislation of...more

Blog: Trend Watch: Government Use Of Data Analytics To Identify Health Care Fraud

Data analytics is not a new concept within the health care industry. However, as data analytics tools become more accessible, government interest in using data analytics to detect health care fraud continues to increase. ...more

Current Developments and Future Trends in False Claims Act Litigation

This past year marked another wildly successful year for the Department of Justice (DOJ) in recovering nearly six billion dollars as a result of False Claims Act (FCA) enforcements, settlements and qui tam whistleblower...more

Texas Hospital Settles Stark Statute and False Claims Act Allegations for $21.75 Million

According to a press release from the Department of Justice, Citizens Medical Center (“CMC”), a county-owned hospital in Victoria, Texas, will pay $21,750,000 to the federal government to settle allegations that it entered...more

Mintz Levin Health Care Qui Tam Update - Recently Unsealed Whistleblower Cases

Trends & Analysis - ..We have identified 67 health care–related qui tam cases that have been unsealed since the cases covered in our last Qui Tam Update. Of those cases, 29 were filed before January 1, 2014, with seven...more

Two Laboratories Settle Claims Regarding Specimen Processing Fees

Continuing the scrutiny of laboratory arrangements with referring physician practices, the United States Department of Justice (DOJ) recently announced the settlement of False Claims Act allegations against two cardiovascular...more

Judge Endorses Extrapolation Techniques for False Claims Act Whistleblowers

In a lawsuit brought under the False Claims Act ("FCA") a federal district judge in Florida recently rejected a defendant's challenge to a statistical sampling and extrapolation methodology advanced by a qui tam plaintiff's...more

What to Do if You Receive a Subpoena for Documents From the US Department of Justice

Receiving an unexpected Department of Justice (“DOJ”) subpoena for documents and testimony is a jarring experience for anyone in Government contracting. But more and more contractors may receive such subpoenas as the...more

Maryland’s New False Claims Act: Is It Enough?

Maryland Senate bill 374 (cross filed with House bill 405) has made its way to Governor Larry Hogan’s desk for signature. Championed by Attorney General Brian Frosh, the bill expands Maryland’s False Claims Act from its...more

Court Rules: Standard for Evaluating Reimbursement of Skilled Nursing Medicare Claims Was Material Improvement

A False Claims Act (“FCA”) lawsuit in Georgia was dismissed on March 31, 2015, after a federal district judge ruled that the government’s expert witnesses used the wrong standard to determine whether certain skilled therapy...more

The Medical-School-to-Prison Pipeline Continues to Widen

Physicians now appear to be more than ever at a greater risk of investigation for healthcare crimes, largely due to their “gatekeeping” function concerning a patient’s need for medical services and the government’s increased...more

OIG Provides Additional Compliance Guidance for Healthcare Governing Boards

On April 20, 2015, the HHS Office of Inspector General (HHS OIG), in collaboration with the American Health Lawyers Association (AHLA), the Association of Healthcare Internal Auditors (AHIA), and the Health Care Compliance...more

MACRA’s Advancement of EHR Interoperability and Telehealth

This is the fourth and final post in our series on the Medicare Access and CHIP Reauthorization Act (MACRA). Pub.L. No. 114-10. We’ve previously covered the repeal of the Sustainable Growth Rate (SGR) in our April 20th post,...more

OMHA Announces Award of ECAPE Contract

The Office of Medicare Hearing and Appeals (OMHA) announced April 14, 2015 that the development contract for the Electronic Case Adjudication and Processing Environment (ECAPE), the dynamic workflow and case management system...more

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