News & Analysis as of

Fraud and Abuse

FINRA's Newest One-Two Punch

by Reminger Co., LPA on

On February 3, 2017, the SEC approved: (1) new FINRA Rule 2165 (Financial Exploitation of Specified Adults[1]) permitting members to place temporary holds on certain customer accounts where there is a reasonable belief of...more

USCIS H-1B Cap Numbers

by Cozen O'Connor on

The U.S. Citizenship and Immigration Services (USCIS) announced on April 7, 2017 that the agency reached the congressionally mandated number of 65,000 visa H-1B Cap petitions for FY2018. USCIS reported on April 17, 2017 that...more

H-1B Cap Reached; President Trump Signs H-1B Executive Order

On April 7, only five business days into the filing season, U.S. Citizenship and Immigration Services (USCIS) announced that it had already received a sufficient number of H-1B petitions to reach the statutory caps for both...more

WARNING: New York Percentage Billing Arrangements Under Attack. Medicaid Frad Unit Is Seeking Recoupment from Providers Using...

New York’s Medicaid Fraud Control Unit (“MFCU”) has sent demand letters seeking recoupment from certain healthcare providers in New York State who have percentage of collection arrangements with their outside billing...more

Securities Legislative Update – Elderly Investors 2017

The SEC recently approved FINRA’s proposed rule aimed at preventing fraud and abuse of senior investors. On March 30, FINRA issued Regulatory Notice 17-11, setting the effective date for the new rule as February 5, 2018. The...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

ASLMS Annual Meeting Special Coverage: Legal and Compliance Issues Impacting Medical Practices Using Laser Technology

by Ruder Ware on

Medical practices that routinely use laser technology are subject to some of the same legal issues as other types of practices. Use of lasers creates additional compliance issues and highlights certain compliance risk areas....more

H-1B Updates from USCIS

by Mintz Levin on

“Computer Programmer” as a Specialty Occupation - On March 31, 2017, USCIS released a policy memorandum addressing the adjudication and review of H-1B petitions for Computer Programmers. The memorandum rescinded a...more

USCIS Announces New Measures to Detect H-1B Visa Fraud and Abuse

by Bracewell LLP on

On April 3, 2017, the United States Citizenship and Immigration Services (“USCIS”) announced heightened measures to deter and detect H-1B visa fraud and abuse. In its site visits to H-1B petitioners and the worksites of H-1B...more

Immigration Fact and Fiction for the U.S. Employer: All Those Announcements About H-1B’s – Is the Program Really Being...

Timed to coincide with the date when thousands upon thousands of H-1B petitions, subject to the quota cap limitation are filed with Service Centers of United States Citizenship and Immigration Services, various government...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

USCIS Announces Measures to Detect H-1B Visa Fraud and Abuse

by Cozen O'Connor on

On April 3, 2017, The U.S. Citizenship and Immigration Services (USCIS) announced multiple measures in an effort to deter and detect H-1B visa fraud and abuse. Starting this month, USCIS will focus on the following when...more

Trump’s Budget Proposal: Increased Spending for Health Care Fraud Enforcement

by Williams Mullen on

Last week, President Donald J. Trump released his first proposed budget. Amidst headline making cuts to agencies such as the Environmental Protection Agency, the State Department and the Department of Agriculture and spending...more

President’s Proposed Budget Increases Healthcare Fraud Enforcement Funding

by McGuireWoods LLP on

Much of the discussion surrounding President Trump’s 2018 budget blueprint has focused on cuts, but one proposed budget increase shows the new administration is likely to continue focusing on healthcare fraud enforcement. ...more

President’s Budget Blueprint Increases Funds For Health Care Fraud Enforcement

The President has released a “budget blueprint” for fiscal year 2018. Although there are many aspects of the budget blueprint to digest, several budget items signal that government health care fraud enforcement remains a...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

The Case of the Very Very Impossibly Long, Terrible, Horrible, No Good, Very Bad Day

by Ruder Ware on

How Fraud and Abuse Cases Arise in a Medical Practice - It is no secret many doctors work very long days. Some days are worse and some are better than others. As a compliance lawyer, my job is to attempt to prevent...more

HHS Report Acknowledges Complications of Fraud and Abuse Statutes on Value-Based Arrangements

by King & Spalding on

HHS posted a report to Congress on its website in August 2016 that responds to the requirements in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to offer legislative and regulatory suggestions regarding the...more

Fourth Circuit Permits DOJ to Reject an FCA Settlement, But Punts Decision on Statistical Sampling

In a closely watched False Claims Act (“FCA”) case, the Fourth Circuit Court of Appeals decided that the Department of Justice (“DOJ”) has an unreviewable right to object to a proposed settlement agreement between a relator...more

DOJ/OIG Update on FY 2016 Health Care Fraud and Abuse Control (HCFAC) Program Recoveries

by Reed Smith on

Federal health fraud recoveries for FY 2016 totaled $3.3 billion, according to the latest HCFAC program annual report. The HCFAC program is credited with more than $31.0 billion in Medicare Trust Funds recoveries since it...more

Affordable Care Act Repeal

by 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

CMS and OIG Issue Notice of Amended Waivers for Next Generation ACO Model

by King & Spalding on

On December 29, 2016, CMS and OIG issued a Notice of Amended Waivers of Certain Fraud and Abuse Laws in Connection with the Next Generation ACO Model (the 2016 Notice). The 2016 Notice does not change or limit arrangements...more

Health Care Enforcement Review and 2017 Outlook: Yates Memo in Action

Happy New Year! As we kick off 2017, our Health Care Enforcement Defense team brings you its annual review of key government policies, regulations, and enforcement actions in 2016, and the impact these trends are expected to...more

OIG Approves Another Medigap/Preferred Hospital Network Arrangement in Advisory Opinion 16-11

by Baker Ober Health Law on

On November 3, 2016, the OIG issued another favorable Advisory Opinion, No. 16–11, regarding an agreement between a Medigap insurer and preferred hospital network. The OIG has issued several opinions regarding similar...more

The Federal Government Holds Individuals Responsible for Involvement in Corporate Healthcare Fraud and Abuse

by Sherman & Howard L.L.C. on

In September 2016, three corporate officers in two healthcare fraud and abuse cases settled allegations that they were personally liable for violations of federal fraud and abuse laws. These settlements come one year after...more

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