Recognizing the ongoing impact of the cyberattack experienced by Change Healthcare/Optum on February 21, 2024, the Centers for Medicare & Medicaid Services (CMS) announced over the weekend that it will allow Part A providers...more
We are pleased to bring you our 12th annual Healthcare Fraud & Abuse Review. Our Review provides comprehensive coverage of the most significant civil and criminal enforcement issues facing healthcare providers. Each year, we...more
2/27/2024
/ Anti-Kickback Statute ,
CARES Act ,
Coronavirus/COVID-19 ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare ,
Healthcare Fraud ,
Kickbacks ,
Medical Devices ,
Pharmaceutical Industry ,
Physicians ,
Prescription Drugs ,
Qui Tam ,
Settlement ,
Stark Law ,
Telemedicine
On November 6, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) released the most up-to-date, comprehensive, and practical general compliance guidance in decades. The new...more
12/7/2023
/ Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare ,
Investment ,
New Guidance ,
OCR ,
OIG ,
Private Equity
Please join us for the 9th Annual Nashville Healthcare Fraud Conference hosted by Bass, Berry & Sims and the Tennessee Hospital Association. Eligible for more than seven hours of CLE credit (including ethics), this...more
11/27/2023
/ Anti-Kickback Statute ,
C-Suite Executives ,
Chief Compliance Officers ,
Chief Privacy Officer ,
Continuing Legal Education ,
Criminal Liability ,
Department of Justice (DOJ) ,
Enforcement ,
Ethics ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare Facilities ,
Healthcare Fraud ,
Hospitals ,
Laboratories ,
Long-Term Care ,
MCOs ,
Mental Health ,
Physicians ,
Self-Disclosure Requirements ,
Substance Abuse ,
Webinars
Please join us for the 9th Annual Nashville Healthcare Fraud Conference hosted by Bass, Berry & Sims and the Tennessee Hospital Association. Eligible for more than seven hours of CLE credit (including ethics), this...more
11/27/2023
/ Anti-Kickback Statute ,
C-Suite Executives ,
Chief Compliance Officers ,
Chief Privacy Officer ,
Continuing Legal Education ,
Criminal Liability ,
Department of Justice (DOJ) ,
Enforcement ,
Ethics ,
Events ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare Facilities ,
Healthcare Fraud ,
Hospitals ,
Laboratories ,
Long-Term Care ,
MCOs ,
Mental Health ,
Physicians ,
Self-Disclosure Requirements ,
Substance Abuse
The Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) continues to offer valuable insights to the healthcare industry as to how best to approach increasingly complex healthcare fraud...more
4/11/2023
/ Advisory Opinions ,
Consolidated Appropriations Act (CAA) ,
Department of Health and Human Services (HHS) ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare ,
Healthcare Reform ,
OIG ,
Physicians ,
Request For Information ,
Self-Disclosure Requirements ,
Telemedicine ,
Wellness Programs
As addressed in the first installment of this three-part series, healthcare providers face potential audits from an increasing number of Medicare and Medicaid contractors. Failing to respond properly can lead to significant...more
Because Medicare and Medicaid claims audit requests can look like routine billing-related correspondence, they can be easy to miss, leading to expensive and potentially catastrophic consequences. Providers, therefore, should...more
On February 6, the U.S. District Court for the Eastern District of Texas vacated key provisions in the regulations implementing a federal arbitration process to settle out-of-network (OON) payment disputes between payers and...more
The Health Resources and Services Administration (HRSA) is seeking repayment of Provider Relief Fund (PRF) payments from providers who failed to submit the required report(s) on their use of the funds. Recipients were...more
The Office of Inspector General (OIG) for the U.S. Department of Health and Human Services recently posted Advisory Opinion 22-20, approving an acute care hospital’s arrangement under which its employed nurse practitioners...more
1/6/2023
/ Acute Facilities ,
Advisory Opinions ,
Anti-Kickback Statute ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Hospitals ,
Nurse Practitioners ,
OIG ,
Physicians ,
Remuneration ,
Stark Law
On December 2, the Department of Health and Human Services (HHS) announced it would not begin enforcement of a key requirement under the No Surprises Act (NSA) starting January 1, 2023, as previously scheduled...more
Ensuring compliance with the False Claims Act has never been more important for healthcare providers. By March 2020, we saw healthcare professionals standing at the forefront of one of the greatest health crises in a...more
2/4/2021
/ Annual Reports ,
Anti-Kickback Statute ,
CARES Act ,
Coronavirus/COVID-19 ,
Criminal Investigations ,
Criminal Prosecution ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Fraud and Abuse ,
Health Care Providers ,
Healthcare Facilities ,
Healthcare Fraud ,
Long Term Care Facilities ,
Medical Devices ,
Medicare ,
Medicare Advantage Organizations (MAOs) ,
Nurses ,
Nursing Homes ,
OIG ,
Opioid ,
Pharmaceutical Industry ,
Pharmacist ,
Physicians ,
Qui Tam ,
Settlement Agreements ,
Stark Law ,
Telemedicine
The Medicare Physician Fee Schedule Final Rule for Calendar Year 2021 (the Final Rule) issued by the Centers for Medicare & Medicaid Services (CMS) on December 1, 2020, and published in the Federal Register on December 28,...more
1/5/2021
/ Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Drug Treatment ,
Final Rules ,
Health Care Providers ,
Medical Coding ,
Medicare ,
Opioid ,
Physician Fee Schedule ,
Physicians ,
Public Health Emergency ,
Reporting Requirements ,
Scope of Treatment ,
Telehealth ,
Vaccinations ,
Verification Requirements
In a coordinated effort, on November 27, 2020, the Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) published final rules to modernize regulations implementing the federal...more
12/22/2020
/ Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Final Rules ,
Health Care Providers ,
New Value Exception ,
OIG ,
Pharmacy Benefit Manager (PBM) ,
Physicians ,
Rebates ,
Safe Harbors ,
Stark Law ,
Technology Sector
On December 4, the U.S. Department of Health and Human Services (HHS) revised its Public Health and Social Services Emergency Fund (Relief Fund) Frequently Asked Questions (FAQs), indicating that providers must return Relief...more
12/9/2020
/ CARES Act ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Financial Reporting ,
Health Care Providers ,
Healthcare Facilities ,
Hospitals ,
Income Taxes ,
Provider Payments ,
Provider Relief Fund ,
Public Health Emergency ,
Relief Measures ,
Tax Revenues
The Health Resources and Services Administration (HRSA) quietly released a Post-Payment Notice of Reporting Requirements (Notice) over the weekend, which provides some initial details regarding the reporting requirements...more
9/23/2020
/ Borrowers ,
CARES Act ,
Coronavirus/COVID-19 ,
Deadlines ,
Guidance Update ,
Health Care Providers ,
HRSA ,
Provider Relief Fund ,
Reimbursements ,
Relief Measures ,
Reporting Requirements ,
Time Extensions
The U.S. Department of Health and Human Services (HHS) recently issued new guidance regarding reporting and auditing requirements that may impact providers and suppliers who retain payments received from the Public Health and...more
8/10/2020
/ Audit Policies ,
Children's Health Insurance Program (CHIP) ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Hospitals ,
Medicaid ,
New Guidance ,
Provider Relief Fund ,
Secretary of HHS ,
Skilled Nursing Facility ,
Suppliers
As Tennessee continues to look for options to expand access to opioid treatment services, a new Tennessee law expands the types of providers who may prescribe medication-assisted treatment and imposes certain financial...more
To address the ongoing national emergency from the COVID-19 pandemic, on March 30, the Centers for Medicare & Medicaid Services (CMS) issued blanket waivers of the federal Physician Self-Referral Law, otherwise known as the...more
On March 17, 2020, the Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) issued a Policy Statement addressing the ability of physicians and other practitioners to reduce or waive patient...more
3/23/2020
/ Coronavirus/COVID-19 ,
Cost-Sharing ,
Department of Health and Human Services (HHS) ,
Emergency Response ,
Health Care Providers ,
OIG ,
Physicians ,
Policy Statement ,
State of Emergency ,
Telehealth ,
Waivers
On December 20, 2019, the U.S. Court of Appeals for the Third Circuit granted in part a petition for rehearing filed by the University of Pittsburgh Medical Center (UPMC) in a False Claims Act (FCA) case that has generated...more
12/30/2019
/ False Claims Act (FCA) ,
Health Care Providers ,
Hospitals ,
Patient Referrals ,
Petition For Rehearing ,
Physician Compensation Arrangements ,
Physicians ,
Pleading Standards ,
Relators ,
Reversal ,
Stark Law
On November 15, 2019, the Centers for Medicare & Medicaid Services (CMS) finalized a rule requiring hospitals to make public a list of standard charges for items and services provided by such hospitals (the Rule). (The...more
11/27/2019
/ Centers for Medicare & Medicaid Services (CMS) ,
Disclosure Requirements ,
Final Rules ,
Health Care Providers ,
Health Plan Sponsors ,
Healthcare ,
Healthcare Costs ,
Hospitals ,
Physicians ,
Price Transparency ,
Proposed Rules ,
Public Health Service Act
In a coordinated effort, CMS and the Office of Inspector General (OIG) published proposed rules to modernize regulations implementing the federal physician-self referral law, commonly referred to as the “Stark Law” (Stark),...more
10/30/2019
/ Anti-Kickback Statute ,
Beneficiary Inducement ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Comment Period ,
Department of Health and Human Services (HHS) ,
EHR ,
Health Care Providers ,
OIG ,
Proposed Rules ,
Public Comment ,
Safe Harbors ,
Stark Law ,
Value-Based Care
The U.S. Court of Appeals for the Third Circuit recently issued a False Claims Act (FCA) decision calling into question productivity-based physician compensation structures under the Stark Law, in reliance on a controversial...more
10/15/2019
/ Appeals ,
Centers for Medicare & Medicaid Services (CMS) ,
Dismissals ,
False Claims Act (FCA) ,
Health Care Providers ,
Hospitals ,
Physician Compensation Arrangements ,
Physicians ,
Pleading Standards ,
Provider Payments ,
Relators ,
Reversal ,
Stark Law ,
Tuomey