News from the Health Law Gurus™: July 2014

News from the Health Law Gurus™ is a weekly summary of notable health law news from around the country with helpful links to related content.

$1 Million Settlement Reached in $73 Million Overbilling FCA Suit—Florida-based Halifax Health (“Halifax”) has settled a False Claims Act (“FCA”) suit brought by whistleblower and former compliance officer Elin Baklid-Kunz for $1 million. In the suit, Baklid-Kunz alleged that between 2002 and 2013, Halifax admitted patients for unnecessary and expensive inpatient procedures resulting in overbilling of Medicare in the amount of $73 million dollars. This settlement comes after Halifax reached an $85 million settlement in March over allegations that it had improper financial relationships with referring physicians. The Department of Justice (“DOJ”) has until July 21, 2014 to approve of the settlement. Read a Modern Healthcare article on the settlement here.  

Survey of ACA Navigators Finds 10.6 Million People Sought Enrollment Help—In a survey released this week, the Kaiser Family Foundation (“Kaiser”) estimates that approximately 10.6 million people received assistance from “navigators” in shopping for and enrolling in health insurance plans through the Affordable Care Act (“ACA”) health insurance exchange (also referred to as the “marketplace”). Navigators are required by the ACA, and their job is to help consumers understand coverage options, apply for assistance, and enroll. Kaiser found that the more than 28,000 full-time equivalent staff and volunteer navigators provided help to consumers, a majority of whom did not understand the ACA or terms like “deductible” or “network service.” To read the Kaiser survey, click here.

Bill to Address Hobby Lobby Decision Blocked by Senate—A Senate bill backed by Democrats and aimed at addressing the Supreme Court’s decision in Burwell v. Hobby Lobby failed to pass the Senate on Wednesday. In Hobby Lobby, the Supreme Court held that closely-held corporations do not need to comply with the ACA’s so-called “Contraception Mandate” if they object to providing employees with contraceptives on religious grounds. The Senate bill would have required that all for profit employers provide contraception coverage to their employees, regardless of religious objections, essentially bypassing the Supreme Court’s Hobby Lobby ruling. The bill’s supporters could not muster the necessary 60 votes to pass the Senate in the 56-43 vote. Read a Washington Post article on the bill here.

29th Defendant Admits to Taking Bribes in Widespread Lab Referral Bribe Scheme—New York doctor Peter Deplas pled guilty to taking bribes from Biodiagnostic Laboratory Services LLC of Parsippany, New Jersey (“BLS”) in exchange for referrals for lab services, according to a DOJ press release. The larger scheme involved BLS paying millions of dollars in bribes in return for referrals resulting in over $100 million in payments to BLS from payors, including Medicare. For his part, Deplas admitted to taking approximately $120,000 in bribes in the form of sham lease payments and cash payments. Deplas, the eighteenth physician to plead guilty in the scheme, will be sentenced at the end of October and faces up to five years in prison and a fine of $250,000. Read the full DOJ press release here.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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