Telemedicine saw a dramatic increase during the COVID-19 pandemic. A recent study from the U.S. Department of Health and Human Services (HHS), released in December 2021, showed an increase in Medicare telemedicine visits...more
9/14/2022
/ Anti-Kickback Statute ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Health Care Providers ,
Healthcare ,
Healthcare Fraud ,
Medical Reimbursement ,
Medicare ,
OIG ,
Patient Access ,
Telehealth ,
Telemedicine
Prosecutions related to the submission of claims to Tricare for compounded pain creams continue. The Eleventh Circuit Court of Appeals affirmed convictions against a Florida pharmacist, physician, and Navy veteran for their...more
6/20/2022
/ Anti-Kickback Statute ,
Criminal Prosecution ,
Drug Compounding ,
Enforcement Actions ,
Health Care Providers ,
Healthcare ,
Healthcare Fraud ,
Indictments ,
Kickbacks ,
Military Service Members ,
Pharmaceutical Industry ,
Physicians ,
Prescription Drugs ,
TRICARE
HELPFUL HINTS -
The Federal No Surprises Act The Federal No Surprises Act (the “Act”) became fully effective on January 1, 2022. The Act protects enrollees in group and individual market plans (including ERISA plans) and...more
1/25/2022
/ Advisory Opinions ,
Anti-Kickback Statute ,
Biden v Missouri ,
Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Employer Mandates ,
Healthcare ,
Healthcare Fraud ,
Healthcare Reform ,
Healthcare Workers ,
Infectious Diseases ,
Mental Health ,
National Federation of Independent Business v Department of Labor and OSHA ,
New Legislation ,
OIG ,
OSHA ,
Surprise Medical Bills ,
Vaccinations
With the continued proliferation of qui tam False Claims cases showing no signs of slowing down, not only must providers consider the amount of any monetary settlements, they must also consider whether the Office of Inspector...more
According to the United States Government, fraud and abuse recovery has an excellent return for each investment dollar spent. According to the Health Care Fraud and Abuse Control (HCFAC) Program Report,released by the...more
2/16/2017
/ Civil Monetary Penalty ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare Fraud ,
Medicaid ,
Medicare ,
Obstruction of Justice ,
OIG ,
Physicians ,
Settlement ,
Unjust Enrichment
The Supreme Court decided Universal Health Services v. U.S. ex rel. Escobar on June 16, 2016 in which it ruled the implied false certification theory, previously recognized in several circuits, can form the basis for False...more
9/7/2016
/ Conditions of Payment ,
False Claims Act (FCA) ,
False Implied Certification Theory ,
Federal Contractors ,
Health Care Providers ,
Healthcare Fraud ,
Implied Certification ,
Material Misrepresentation ,
Materiality ,
Medicaid ,
Mental Health ,
SCOTUS ,
Universal Health Services Inc v United States ex rel Escobar ,
Unlicensed Medical Providers