News & Analysis as of

Anti-Kickback Statute

The Anti-Kickback Statute is a United States federal criminal statute that prohibits the exchange (or the promise to exchange) of anything of value for referrals of federal healthcare program business. The... more +
The Anti-Kickback Statute is a United States federal criminal statute that prohibits the exchange (or the promise to exchange) of anything of value for referrals of federal healthcare program business. The statute aims to prevent situations where government officials channel federal healthcare dollars towards particular providers, who have offered or given the official a personal benefit. Penalties for violation of the Anti-Kickback statute apply to both sides of a prohibited transaction and can include jail time and steep monetary fines. less -

Ambulatory Surgery Center (ASC) Case Demonstrates Differential Value Theory of Remuneration

by Ruder Ware on

A relatively recent case involving buy-in terms in an ambulatory surgery center demonstrates how different valuations for referral sources and non-referral sources can be evidence of remuneration under the Medicare...more

Healthcare Fraud and Abuse Review 2016

by Bass, Berry & Sims PLC on

Bass, Berry & Sims is pleased to announce the release of its fifth annual Healthcare Fraud and Abuse Review 2016. The Review, compiled by the firm’s Healthcare Fraud Task Force, is an industry-leading guide to healthcare...more

Free Or Discounted Local Transportation: To Offer It Or Not?

On December 7, 2016, the Department of Health and Human Services, Office of the Inspector General (the “OIG”) published a final rule (the “Final Rule”) (that took effect January 6, 2017) that, among other things, added a new...more

New OIG Rules Change Patient Incentive Program Landscape: Where Are the Limits Now?

by McDermott Will & Emery on

With health care becoming more consumer-driven, health care providers and health plans are wrestling with how to incentivize patients to participate in health promotion programs and treatment plans. As payments are...more

Leasing to Health Care Tenants: What You Need to Know

by Pepper Hamilton LLP on

Commercial office building landlords frequently find themselves leasing to health care provider tenants. A landlord may not consider doctor’s offices or diagnostic labs as specialty uses, but there are several lease...more

New Safe Harbor Permits Some Free Transportation to Patients

by Ruder Ware on

A new safe harbor was recently issued by the Health and Human Services (HHS) Office of Inspector General (OIG) that permits eligible health care providers to offer free or discounted transportation to established patients....more

Provider Beware: MACRA Implementation Fraught with Fraud and Abuse Implications

by Carlton Fields on

Although the fate of the Center for Medicare and Medicaid Innovation (CMMI) and the mandatory alternative payment models thereunder face threat of repeal under Republican leadership, the Medicare Access and Chip...more

Jurisdiction to Freeze Assets but Not to Thaw Them

by Faegre Baker Daniels on

A recent Fourth Circuit opinion in a False Claims Act case demonstrates that while the government can freeze defendants’ assets before trial with lightning speed, getting them unfrozen can take anywhere from many years to...more

When to Use the OIG’s Self Disclosure Protocols

by Ruder Ware on

The HHS Office of Inspector General offers providers an opportunity to self-disclose certain violations in exchange for avoiding some of the more draconian penalties that may otherwise apply under applicable regulations. ...more

U.S. District Court Rules that Hospital May Face FCA Liability Over Medical Directorship Arrangements that Lacked Written...

by King & Spalding on

On March 15, 2017, the U.S. District Court for the Western District of Pennsylvania held in United States ex rel. Emanuele v. Medicor Assocs., 2017 BL 80113, W.D. Pa., No. 10-cv-245, 3/15/17, that a hospital that created...more

Healthcare Law Update: March 2017

by Holland & Knight LLP on

Enforcement - OIG Issues Advisory Opinion Allowing Free or Reduced-Cost Lodging and Meals - On March 3, 2017, the U.S. Department of Health and Human Services' (HHS) Office of Inspector General (OIG) issued...more

OIG Approves Free Lodging and Meals Under "Promotes Access to Care" Exception to Beneficiary Inducement CMP

by Baker Ober Health Law on

In Advisory Opinion 17-01, published March 10, 2017, the Department of Health and Human Services, Office of Inspector General (OIG) approved an academic medical center's proposal to provide free or reduced-cost lodging and...more

Mintz Levin Health Care Qui Tam Update - Recently Unsealed Whistleblower Cases: March 2017

by Mintz Levin on

Trends & Analysis - ..This issue looks at 18 health care–related qui tam cases that were unsealed in whole or in part in late October through November 2016. ..The cases identified were filed in federal district courts...more

Drug and Device Makers Suggest Anti-Kickback Safe Harbor Clarifications to Encourage Value-Based Health Care Arrangements

by Ropes & Gray LLP on

In response to the annual solicitation by the Office of Inspector General (“OIG”) of the U.S. Department of Health and Human Services (“HHS”) for developing new, and modifying existing, safe harbors to the anti-kickback...more

Pharmaceutical Manufacturers and Healthcare Leaders cite Fraud and Abuse Laws as Obstacle to Value-Based Arrangements

As the healthcare industry moves towards value-based purchasing, pay-for-performance, and other payment reform models, industry leaders have identified federal fraud and abuse laws as a barrier to full implementation of such...more

Vavra Decision Highlights Avenues for Potential Anti-Kickback Act Liability

On February 3, 2017, the Fifth Circuit decided US ex rel Vavra v. Kellogg Brown & Root, No. 15-41623, 2017 WL 473873 (5th Cir. 2017), determining that defendant KBR could be held vicariously liable under the enhanced penalty...more

What’s in Your Local Transportation Policy?

by Nossaman LLP on

Those in the business of providing healthcare services to Medicare and Medicaid beneficiaries are all too familiar with the federal Anti-kickback Statute (AKS). Among other dreadful sanctions, it imposes criminal penalties on...more

Ambulatory Surgery Center Physician Exclusions - Reducing Risk of Forced Redemption of ASC Investment Interests

by Ruder Ware on

Many surgery centers are eventually faced with decisions about how to treat investing physicians who do not perform as many procedures in the surgery center as others. Under performing physicians can create political issues...more

New OIG Exclusion Regulations About to Go into Effect

by McDermott Will & Emery on

The Office of Inspector General (OIG) recently published a final rule regarding its exclusion authorities. The final rule goes into effect March 21, 2017, and expands OIG’s authority to exclude certain individuals and...more

Nutter Bank Report, February 2017

CFPB Fines Mortgage Lender for Violating the RESPA Anti-Kickback Rule The Consumer Financial Protection Bureau (“CFPB”) has taken enforcement action in the form of a consent order against a mortgage lender, including...more

OIG Finalizes Expanded Exclusion Authorities under ACA (Updated)

by Reed Smith on

On January 12, 2017, the Office of Inspector General (OIG) of the Department of Health and Human Services issued the final rule implementing its statutory authority under the Affordable Care Act (ACA) to expand the exclusion...more

Stretching the Rules: HHS-OIG Expands its Exclusionary Authority

by Arnall Golden Gregory LLP on

On January 12, 2017, the Department of Health and Human Services’ Office of Inspector General (OIG) published a final rule expanding its authority to exclude providers from participation in federal healthcare programs. This...more

First Circuit Affirms Summary Judgment for Defendant, Rejecting the Use of Aggregate Data to Prove False Claims and Clarifying the...

by Ropes & Gray LLP on

The First Circuit has issued an opinion affirming a complete grant of summary judgment for Pfizer, Inc. in United States ex rel. Booker v. Pfizer Inc., No. 16-1805 (1st Cir. Jan. 30, 2017), a False Claims Act (“FCA”) lawsuit...more

10 Key FCA Developments Of 2016

by Morrison & Foerster LLP on

2016 was another active year in the land of False Claims Act enforcement. The U.S. Department of Justice continued to set recovery records and turned its eye more keenly on enforcement of individuals. We heard from the...more

OIG Expands Exclusionary Authority

The Department of Health and Human Services, Office of Inspector General (OIG) published a final rule on January 12, 2017, expanding the OIG’s authority to exclude providers from participation in federal healthcare programs....more

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