News & Analysis as of

Patient Protection and Affordable Care Act (PPACA) › Fraud and Abuse

The Patient Protection and Affordable Care Act (PPAC), also known as Obamacare, is a United States federal statute passed in March of 2010. The Act creates a nationwide insurance system and provides federal... more +
The Patient Protection and Affordable Care Act (PPAC), also known as Obamacare, is a United States federal statute passed in March of 2010. The Act creates a nationwide insurance system and provides federal subsidies to reduce the number of uninsured citizens. less -
Sheppard Mullin Richter & Hampton LLP

Eighth Circuit: In False Claims Act Cases Based On Kickback Violations, the Kickback Violation Must Be the “But For” Cause of the...

Sheppard Mullin Richter & Hampton LLP on

The Eighth Circuit Court of Appeals recently tossed a $5.5 million jury verdict finding that a physician violated the False Claims Act (“FCA”) by submitting claims for items and services ordered subsequent to a violation of...more

McDermott Will & Emery

Are Out-of-Pocket Costs on Their Way Out? At-Home COVID-19 Testing and Expanded Preventative Healthcare for Women and Children

McDermott Will & Emery on

In response to a directive from the White House, based on provisions of the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief and Economic Security (CARES) Act that eliminated cost sharing for...more

Bass, Berry & Sims PLC

Healthcare Fraud & Abuse Review 2017

Bass, Berry & Sims PLC on

A LOOK BACK... A LOOK AHEAD - While the uncertainty associated with legislative efforts to repeal the Patient Protection and Affordable Care Act (PPACA) dominated most of the headlines for the healthcare industry last year,...more

Manatt, Phelps & Phillips, LLP

Manatt on Health Reform: Weekly Highlights - May 2017 #4

Manatt, Phelps & Phillips, LLP on

The President's budget proposes over $600 billion in Medicaid cuts on top of major reductions anticipated in repeal and replace legislation; the Trump Administration asks the Court for more time to decide on cost-sharing...more

Dickinson Wright

Affordable Care Act Repeal

Dickinson Wright on

Recently the Wall Street Journal stated the New England Journal of Medicine published an op-ed by President Obama in which he critiqued the Republicans’ strategy to repeal the Affordable Care Act, and then replace it at a...more

Mintz - Health Care Viewpoints

Senate Committee Releases Report on Potential Stark Law Changes, Hearing Scheduled

Mintz - Health Care Viewpoints on

On June 30, 2016, the Senate Finance Committee’s Republican staff issued a 20-page report discussing comments made by industry stakeholders after a December 2015 round-table on the future of the physician self-referral law,...more

BakerHostetler

OIG Revamps Regulations Concerning CMPs and Exclusion

BakerHostetler on

In a pair of proposed rules published in May, the HHS OIG unveiled changes to the regulations concerning OIG’s authority to impose civil monetary penalties (CMPs) and exclude individuals and entities from participation in...more

King & Spalding

Office of Management and Budget (OMB) Reviewing Two Proposed Fraud & Abuse Rules

King & Spalding on

On February 5, 2014, the OMB received two proposed rules from the Department of Health and Human Services Office of the Inspector General (OIG). One proposed rule would, among other things, update OIG’s regulations to...more

Akerman LLP - Health Law Rx

Predictions For Top 10 Healthcare Stories For 2014

Akerman LLP - Health Law Rx on

The past year was one of the most eventful in recent memory for healthcare policy. As the Affordable Care Act ("ACA") continued its inexorable, albeit at times wobbly, march towards implementation, the headlines became more...more

Manatt, Phelps & Phillips, LLP

CMS Creates Clarity and Confusion on Application of Fraud and Abuse Laws to Qualified Health Plans

Manatt, Phelps & Phillips, LLP on

On October 30, 2013, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius sent a letter to U.S. Representative Jim McDermott stating that HHS does not consider qualified health plans (QHPs) sold...more

Baker Donelson

Medicare Enrollment Moratoria: Implications for Service Expansion and Certain Transactions

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One of the provisions of the Affordable Care Act provided CMS with the authority to impose a temporary enrollment moratorium for a particular type of provider or supplier if determined to be necessary to combat fraud and...more

The Volkov Law Group

Doctors, Enforcement Risks And Compliance Programs

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Doctors better get used to government regulation. The Affordable Healthcare Act contains a lengthy complement of new laws and regulations. ...more

Baker Donelson

Ordering/Referring Phase 2 Begins May 1st - Claims Will Be Denied

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In an April 24, 2009 transmittal, CMS announced a two-phase claims editing expansion designed to allow verification that the physician or non-physician practitioner (NPP) listed as the ordering/referring provider on a...more

BakerHostetler

10 Fraud and Abuse Enforcement Trends You Can't Afford to Ignore in 2013

BakerHostetler on

To paraphrase a famous quote, "Those who do not learn from history are doomed to repeat it," and providers who ignore the significance of the federal government's healthcare fraud enforcements efforts in 2012 do so at their...more

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