A recent Fourth Circuit opinion in a False Claims Act case demonstrates that while the government can freeze defendants’ assets before trial with lightning speed, getting them unfrozen can take anywhere from many years to...more
A new Fifth Circuit opinion explains the difference between offering a benefit in order to induce a Medicare referral and offering it in the expectation of a referral. The difference is important because the former is a...more
The Massachusetts federal district court is hands-down winner of the August award for strangest regulatory interpretation of the month.
The interpretation came in the context of denial of Omnicare’s summary judgment...more
The White House is reviewing proposed regulations to ease restrictions on certain financial arrangements between hospitals and physicians and on certain transactions between providers and patients. The proposed regulations,...more
On July 7 the Fourth Circuit invoked Flying Pigs to vacate a lower federal court judgment in a Medicaid false claim case, even though neither the lower court nor any of the parties asked it to.
The case started in 2007,...more
Can it be a crime to provide free medical care? That’s the question presented by a post-conviction motion by the so-called King of Nursing Homes, Dr. V. Kuchipudi.
Dr. K was convicted on nine counts of violating the...more
On June 10 the Third Circuit affirmed a lower court’s dismissal of a physician’s qui tam action against Pottstown Memorial Medical Center (PMMC) for violating the Anti-Kickback Statute (AKS) and False Claims Act (FCA). And...more
It’s easy to fall into the habit of regarding self-referrals and kickbacks as strictly a matter of federal law, governed only by the federal Stark Law and Anti-Kickback Statute. But an April 13 verdict in California provides...more
Jeffrey Jacobs alleges that Idaho’s Pocatello Hospital violated the False Claims Act because of physician recruitment contracts that were overly generous to his practice group. Jeff should know because he was recruited under...more
10/7/2015
/ Anti-Kickback Statute ,
False Claims Act (FCA) ,
Hospitals ,
Medicaid ,
Medicare ,
Physicians ,
Recruitment Incentives ,
Recruitment Policies ,
Reimbursements ,
Stark Law ,
Whistleblowers
The Stark Law generally prohibits physicians from referring Medicare and Medicaid patients to facilities in which they have an ownership interest. There used to be a “whole hospital exception” excluding entire hospitals (as...more
Okay, there’s not really a Most-Illegal-Physician-Compensation Prize. But if there were, Florida’s North Broward Hospital District would have won in a walk. That’s why the district has agreed to pay the government $69.5...more
Who knew? When you park for free at your doctor’s office, you may be a pawn in a scheme to violate the Anti-Kickback Statute, the Stark Law, and the False Claims Act. It’s enough to make you sick....more
On July 28 the Office of Inspector General (OIG) of Health & Human Services gave its blessing to a health system’s lease of employees to a related psychiatric system. Under the arrangement the system would also provide...more
Alisia and David blew the whistle on their former employer, Nurses’ Registry & Home Health, for sending gift baskets and ticket events to doctors who referred patients to the home health operation. Their qui tam suit alleged...more
7/22/2015
/ Anti-Kickback Statute ,
Client Referrals ,
False Claims Act (FCA) ,
Gifts ,
Home Health Care ,
Nurses ,
Physician Compensation Arrangements ,
Physicians ,
Qui Tam ,
Stark Law ,
Summary Judgment ,
Whistleblowers
Here’s a nightmare. An arbitrator rules against your hospital for failing to honor an agreement to refer Medicare patients to a home health agency. Why? Because the home health agency paid your hospital good money for the...more
The federal Anti-Kickback Statute makes it a crime to give or receive anything of value in return for “referral” of a Medicare patient. But exactly what is a “referral”? That’s the issue decided by the Seventh Circuit last...more
Brand name drugs cost a lot. So to make them more attractive, drug manufacturers issue coupons for discounts on the copayment portion of the price. They work the same as the dollar-off coupons offered by cereal manufacturers....more
Advisory Opinion No. 14-06, issued August 15, addressed a plan by the chain to reimburse local pharmacies for referrals of patients in need of specialized drugs that the local pharmacies did not dispense. In the scenario...more
In U.S. ex rel. Corporate Compliance Assocs. v. N.Y. Society for the Relief of the Ruptured & Crippled the court ruled that the whistleblower failed to meet the False Claims Act’s requirement that allegations be described...more