News & Analysis as of

Whistleblower Hotline Providers Can Even Save Lives

My mom and dad both have jobs in medicine, so I am some what familiar with how doctors, nurses, and specialists run their practice. My mom works with cancer patients so when I came across this rather shocking article about a...more

HHS OIG Issues Report on Questionable Billing for Medicaid Pediatric Dental Services

What you need to know: The Office of Inspector General for the US Department of Health & Human Services recently published the results of its study on Louisiana dentists who may be providing unnecessary dental...more

The 'Inexorable March' Toward Disclosure of Risk Management Materials

A reminder for risk managers at hospitals and other healthcare organizations in Virginia and elsewhere: Plaintiffs’ attorneys can win access to risk management information long considered protected and internal—including...more

Worthless Services/Substandard Quality of Care Criminal Prosecutions May Be on the Rise

If you are an operator of a skilled nursing facility (SNF), you might have faced the reality of insufficient medical staff and how it impacts your ability to deliver quality patient care to your residents. Or, you might have...more

Recent Cases of Interest to Regulators

Investigative Powers - Sazant v. College of Physicians and Surgeons of Ontario, 2013 CanLII 22324 (S.C.C.), dismissing leave to appeal of a decision in 2012 ONCA 727 - In Sazant, a physician faced both criminal...more

FTC Investigations of Provider Healthcare Transactions: Am I at Risk?

A recent article published in the Antitrust Law Journal titled "A Survey of Evidence Leading to Second Requests at the FTC," by Darren S. Tucker, an attorney advisor to an FTC commissioner who reviewed nonpublic information...more

OIG Reports on Observation Stays and Short Inpatient Stays for Medicare Beneficiaries

The Office of Inspector General (OIG) recently published the results of a study regarding hospitals’ use of observation stays and short inpatient stays for Medicare beneficiaries, citing CMS concerns as one of the reasons for...more

CMS Complaint Investigation Process Changes – What Every Hospital with Deemed Status Should Know

The Centers for Medicare & Medicaid Services (CMS) recently announced revisions to its State Operations Manual that change the complaint survey investigation process and typical timeline for resolution....more

Managing Peer Review Investigations: How to Avoid Hearings and Litigation

In this presentation: - Provide recommendations regarding best practices, bylaw provisions and other strategies to address and resolve quality and peer review issues without resorting to “investigations” and...more

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

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

Which Providers Are at Greatest Risk for Healthcare Fraud Investigations?

At Ashley D. Adams, PLC, we have a well-established track record of success in false claim cases that can make a difference. For both organization defending against false claims charges and individuals pursuing qui tam...more

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