On November 15, 2019, the Centers for Medicare & Medicaid Services ("CMS") finalized changes to the Open Payments Program as part of the CY 2020 Physician Fee Schedule Final Rule. The Open Payments reporting requirements,...more
11/18/2019
/ Centers for Medicare & Medicaid Services (CMS) ,
Continuing Medical Education ,
Final Rules ,
Health Care Providers ,
Medicaid ,
Medicare ,
Open Payments ,
Physician Fee Schedule ,
Physicians ,
Reporting Requirements ,
Sunshine Act ,
Unique Device Identifiers
On Monday, the U.S. Court of Appeals for the Eleventh Circuit issued its long-awaited and closely watched decision in United States v. AseraCare Inc.. The court ruled that a claim cannot be deemed false under the False Claims...more
9/12/2019
/ Defense Strategies ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Hospice ,
Medical Necessity ,
Motion for Summary Judgment ,
Physicians ,
Qui Tam ,
Relators ,
Remand ,
Sua Sponte
On July 30, 2019, the Centers for Medicare & Medicaid Services ("CMS") announced more proposed changes to the Open Payments Program. The Open Payments reporting requirements, otherwise known as the Sunshine Act, require...more
The Tenth Circuit Court of Appeals has issued a significant decision, finding that a physician’s medical judgment about the medical necessity of heart procedures can be “false or fraudulent” under the federal False Claims Act...more
7/16/2018
/ Amicus Briefs ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
False Statements ,
Health Care Providers ,
Local Coverage Determination (LCD) ,
Medical Necessity ,
Motion to Dismiss ,
Objective Falsity ,
Physicians ,
Qui Tam
The long-running test-referral prosecution against Biodiagnostic Laboratory Services, LLC (“BLS”), a New Jersey clinical blood testing laboratory; its owner and employees; and BLS’s referring physicians recently reached...more
7/9/2016
/ Anti-Kickback Statute ,
Bribery ,
Clinical Laboratories ,
Criminal Prosecution ,
Guilty Pleas ,
Healthcare Fraud ,
Individual Accountability ,
Medicare ,
Physicians ,
Service Agreements ,
Yates Memorandum
Earlier today, Attorney General Loretta Lynch announced the largest coordinated crackdown in the Medicare Fraud Strike Force’s eight-year history. The government brought charges against 243 individuals for approximately $712...more
The Centers for Medicare & Medicaid Services (“CMS”) has finalized changes to a number of reporting requirements under the regulations implementing the Physician Payments Sunshine Act (“Final Rule”). When CMS proposed...more
Trends & Analysis:
..We have identified 58 health care–related qui tam cases that have been unsealed since our last Qui Tam Update. Of those, 33 cases were initiated after the start of 2012, with the remaining 25 cases...more
Originally published in the Health Care Fraud Report, 17 HFRA 219, on 03/06/2013.
The final rule (the ‘‘Final Rule’’) implementing the Physician Payments Sunshine Act (‘‘Sunshine Act’’), published in the Federal...more
The long-awaited final rule (the Final Rule) implementing the Physician Payments Sunshine Act (Sunshine Act) has arrived at the Federal Register. It amends key definitions and adds new terms; retains broad reporting...more
2/5/2013
/ Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Continuing Medical Education ,
Data Collection ,
Enforcement ,
GPOs ,
Medicaid ,
Medical Devices ,
Medical Supplies ,
Payment Records ,
Pharmaceutical Industry ,
Physicians ,
Reporting Requirements ,
Sunshine Act