Fraud, Healthcare | JD Supra Law News

Does A Person Submitting False Medicare Bills Abuse The Trust Of The Doctor Making Money Off Of The False Bills?

by Matthew G. Kaiser | The Kaiser Law Firm PLLC on 5/17/2013

Hiring is always hard, especially in a small office. You have work that needs to be done. You can't do it all. Maybe you're a professional, like a doctor, and some of the work isn't the best use of your time....more

The Top 10 Things You Need To Know About The OIG’S Revised Self-Disclosure Protocol

by Laurence Freedman, Laura Laemmle-Weidenfeld | Patton Boggs LLP on 4/23/2013

On Wednesday, April 17, 2013, the Department of Health and Human Services’ Office of Inspector General (OIG) released an updated Self-Disclosure Protocol (SDP) governing the process by which health care providers can...more

OIG Special Fraud Alert Labels Physician-Owned Distributorships (PODs) as “Inherently Suspect”

by Dennis Diaz, Sarah S. Fallows | Davis Wright Tremaine LLP on 4/22/2013

The U.S. Department of Health & Human Services, Office of Inspector General (the “OIG”) issued a Special Fraud Alert (“Alert”) on March 26, underscoring its heightened focus on fraud and abuse risks posed by physician-owned...more

OIG Special Fraud Alert on Physician-Owned Distributorships

by James Henry, Kristen A. Larremore | Bradley Arant Boult Cummings LLP on 4/16/2013

On March 26, 2013, the U.S. Department of Health and Human Services Office of Inspector General (OIG) issued a Special Fraud Alert entitled “Physician-Owned Entities.” The Alert is consistent with an ongoing theme of concern...more

OIG Issues Special Fraud Alert on Business Arrangements with Physician-Owned Entities

by Herschel Goldfield, Malcolm Harkins, III, Edward Kornreich, Elizabeth Mills, Ellen Moskowitz, Richard Zall | Proskauer Rose LLP on 4/15/2013

On March 26, the HHS Office of Inspector General (OIG) issued a Special Fraud Alert (Fraud Alert) reiterating its long-standing concern that the opportunity for a referring physician to earn a profit by investing in a venture...more

Increased Government Scrutiny of Physician-Owned Device Distributorships

by Philip Lebowitz | Duane Morris LLP on 4/3/2013

On March 26, 2013, the Office of Inspector General of the U.S. Department of Health and Human Services (OIG) increased its scrutiny of and pressure on physician-owned entities (particularly medical device distributorships) by...more

OIG Calls PODs "Inherently Suspect"

by Julie Kass, William Mathias, Sanford Teplitzky | Ober|Kaler on 3/29/2013

Making its most strongly worded statement to date, the Department of Health and Human Services Office of Inspector General (OIG) issued a Special Fraud Alert on Physician-Owned Entities on March 26, 2013, calling...more

Physician-Owned Device Companies: OIG Issues Further Guidance

by Anthony Ten Haagen | Holland & Knight LLP on 3/29/2013

The Office of the Inspector General for the United States Department of Health and Human Services (OIG) issued a Special Fraud Alert on March 26, 2013 (the "2013 POD alert"), that identifies physician-owned distributorships...more

New Metropolitan Areas Could Affect Medicare Payment, Regulations

by Emily J. Cook, Eric Zimmerman | McDermott Will & Emery on 3/28/2013

The U.S. Office of Management and Budget recently announced new Metropolitan Areas based on revised standards and 2010 census data. If adopted by Medicare, which they typically are, these changes would affect many aspects of...more

CMS Focuses on Fraud Associated with Increased Use of Electronic Health Records

by Tom Crane | Mintz Levin - Health Law on 3/22/2013

Acting CMS Administrator, Marilyn Tavenner, recently reaffirmed the agency’s concern that the increased use of electronic health records (“EHRs”) has contributed to increases in fraudulent billing practices by providers. At a...more

Health Care Enforcement in 2012: A Year in Review

by Hope Foster, Samantha Kingsbury, Tracy Miner, Jessica Sergi, Stephanie Willis | Mintz Levin - Health Law on 2/26/2013

Last year was another busy year in health care fraud enforcement. In 2012, the Office of Inspector General for the Department of Health and Human Services (HHS-OIG) reported total expected recoveries of $6.9 billion from all...more

Protecting Your Hospital From Over-Utilization Prosecutions

by Michael Volkov on 2/22/2013

The government has been increasing its focus on healthcare fraud involving “quality” of care. This is an extremely difficult issue, especially for prosecutors. It is very difficult to define “quality” standards and then...more

The Healthcare Industry And The Voluntary Disclosure Process

by Michael Volkov on 2/21/2013

It is always important to consider how different parts of the government handle voluntary disclosures. The FCPA enforcement initiative has been largely the result of the voluntary disclosure process, and the government...more

"Ontario Speech From The Throne", Focus On Public Policy, February 2013

by Cyrus Reporter, John Zerucelli | Dentons on 2/20/2013

On Tuesday, February 19th, 2013, the Honourable David Onley, Ontario's Lieutenant Governor, delivered the Wynne government’s Speech from the Throne in the Ontario legislature. Entitled The Way Forward, this speech officially...more

Down The RICO Rabbit Hole: John Reynolds And The Hospital For Special Surgery

by Robert Radick | Morvillo Abramowitz Grand Iason & Anello P.C.... on 2/13/2013

To state that the federal RICO statue has long since slipped the bounds of Congress’s original intent is hardly a novel observation. Although the U.S. Attorney’s Manual points out that "the purpose of the RICO statute is 'the...more

California Gets Tough on Healthcare Fraud and Abuse: Are You Protected?

by Matthew Chayt | Nossaman LLP on 1/31/2013

The industry should take note of new California anti-fraud laws that have recently gone into effect—and the increasing challenges of compliance in a rapidly transforming industry. Even as lawmakers in Sacramento debate how...more

Immigration Alert: January 2013

by Pierre Georges Bonnefil, Patrick Brady, Robert Groban, Jang Hyuk Im, Greta Ravitsky | Epstein Becker & Green, P.C. on 1/30/2013

In this issue: - H-1B Nonimmigrant Season Opens on April 1, 2013, for Fiscal Year 2014 - Report Finds Immigration Laws Frustrate the Admission of Critical Health Care Professionals - Senators Offer...more

Health Care Fraud Restitution Amounts Can't Be Set On Just An Insurance Company Saying It Would Like A Lot Of Money

by Matthew G. Kaiser | The Kaiser Law Firm PLLC on 1/25/2013

Two doctors, married to each other, were accused of health care fraud. They pled guilty and fought at sentencing about the amount of the restitution that they would have to pay back to the insurance companies for what they...more

OIG: Cardiac Catheterization Arrangement Between Hospital and Physicians Not Subject to Sanctions

by King & Spalding on 1/18/2013

On January 7, 2013, HHS OIG published a favorable advisory opinion on a management arrangement between a hospital and a cardiology group related to the provision of certain cardiac catheterization services at the hospital. ...more

What To Do If The Feds Come Knocking At Your Door!

by Jacqueline Arango, Ari H. Gerstin, Bruce Platt, Richard Sharpstein | Akerman Senterfitt on 1/18/2013

Your employee handbook likely addresses, in great detail, the do's and don'ts of using the internet while at the office, guidance on HIPAA, and even the company's policy on sexual harassment, but does it provide any...more

Health Law Update — January 10, 2013

by Darby C. Allen, Ameena Ashfaq, Donna S. Clark, Susan Feigin Harris, Theodore Kobus III, B. Scott McBride, Lynn Sessions, Summer Swallow, Robert Wolin | BakerHostetler on 1/14/2013

In This Issue: - Healthcare Provisions in the American Taxpayer Relief Act - the Good, the Bad and the Ugly - American Taxpayer Relief Act Amends Overpayment Recovery Time Limits - OIG Advisory Opinion Sheds...more

Privatizing Health Insurance Companies For Anti-Fraud Enforcement

by Michael Volkov on 1/8/2013

The federal government faces overwhelming challenges in trying to stem the tide of fraud in the health care system. The problem is massive, and even with the increase in resources, and adoption of new tools to fight fraud,...more

Fraud: Skilled Nursing Facilities And Nursing Homes

by Michael Volkov on 1/7/2013

When it comes to healthcare fraud enforcement, the government knows how to target its resources. It is estimated that at least 25 percent of all claims paid by Medicare are improper. The government understands the...more

Short Wins - Mayan Apocalypse Edition; The World Didn't End, But There Are New Cases On Restitution, Health Care Fraud, Federal...

by Matthew G. Kaiser | The Kaiser Law Firm PLLC on 12/26/2012

One would have thought that, with the end of the world predicted for Friday of last week, our nation's appellate courts would have spent their last week on Earth with family or friends, rather than cranking out wins for folks...more

Record Healthcare Fraud Recovery Calls for Compliance

by Armstrong Teasdale LLP on 12/11/2012

To date in 2012, the Department of Justice secured a record $3.3 billion in settlements and judgments in civil cases alleging healthcare fraud against the government under the Federal False Claims Act (“FCA”). The figure,...more

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