News & Analysis as of September 20, 2024

Anti-Kickback Statute › Provider Payments

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The Anti-Kickback Statute is a United States federal criminal statute that prohibits the exchange (or the promise to exchange) of anything of value for referrals of federal healthcare program business. The... more +

The Anti-Kickback Statute is a United States federal criminal statute that prohibits the exchange (or the promise to exchange) of anything of value for referrals of federal healthcare program business. The statute aims to prevent situations where government officials channel federal healthcare dollars towards particular providers, who have offered or given the official a personal benefit. Penalties for violation of the Anti-Kickback statute apply to both sides of a prohibited transaction and can include jail time and steep monetary fines. less -

“Let’s Talk Compliance”: Medicare Advantage: Compliance Issues and Enforcement

Foley & Lardner LLP on 3/13/2024

Editor’s Note: PYA and Foley & Lardner hosted the 6th Annual “Let’s Talk Compliance” two-day Virtual Conference on January 18 and 19, 2024. Panelists included Foley & Lardner attorneys and PYA experts. The event was hosted by...more

OIG Approves Discount Medical Plan Arrangement with Chiropractors in Advisory Opinion 20-03

Baker Donelson on 7/27/2020

In Advisory Opinion 20-03, published July 1, 2020, the Office of Inspector General (OIG) approved an arrangement in which a discount medical plan organization (DMPO) that receives annual membership fees from its members also...more

CMS Releases Fact Sheets on COVID-19 Medicare Coverage, Billing Guidelines

McDermott Will & Emery on 3/11/2020

The Centers for Medicare and Medicaid Services (CMS) released several fact sheets on COVID-19 coverage and benefits, and announced a second Healthcare Common Procedure Coding System (HCPCS) code, U0002, for billing COVID-19...more

OIG proposes changes to existing Anti-Kickback Statute safe harbors

Bricker Graydon LLP on 11/19/2019

On October 9, 2019, the Office of Inspector General (OIG) released proposed changes interpreting the federal Anti-Kickback Statute (AKS) and its regulatory safe harbors, including changes to several existing safe harbors. ...more

OIG Advisory Opinion 19-04: OIG Approves Health Care Directory's Per-Click Fee Structure

Baker Donelson on 9/24/2019

In Advisory Opinion 19-04, published September 10, 2019, the Office of Inspector General (OIG) approved an online health care directory operated on a per-click or per-booking fee arrangement. The proposed directory will be...more

Thoughts on Recent Amendments to the Florida Patient Brokering Act - The Sky Is Not Falling

Holland & Knight LLP on 8/24/2019

The Florida Legislature recently amended the Florida Patient Brokering Act (PBA), effective July 1, 2019. Since then, a raft of articles have argued that long-standing arrangements between healthcare providers and potential...more

Significant Changes to Florida’s Patient Brokering Act: Uncertainty Lies Ahead - Healthcare Alert

Bradley Arant Boult Cummings LLP on 8/13/2019

A pair of legislative and judicial developments in the last month has the potential to significantly impact healthcare providers doing business in Florida. Until some of the uncertainty is resolved, healthcare providers would...more

Florida Patient Brokering Act Amended – Does it Clarify or Create New Issues?

Akerman LLP - Health Law Rx on 7/1/2019

The Florida Legislature recently passed HB 369 (the Bill), which would tweak an important provision of the Florida Patient Brokering Act, Section 817.505 of the Florida Statutes (Patient Brokering Act)....more

OIG Submits Spring 2019 Semiannual Report to Congress

Baker Donelson on 6/24/2019

The U.S. Department of Health and Human Services, Office of Inspector General (OIG), recently published its Spring 2019 Semiannual Report to Congress. The report, released June 3, 2019, covers the period October 1, 2018...more

Life Sciences Due Diligence: A Reference Guide for Your Life Sciences Corporate Transactions

Akin Gump Strauss Hauer & Feld LLP on 5/2/2019

• Life sciences companies are subject to rapidly changing regulatory obligations, government enforcement, and increasing public scrutiny. • Conducting effective legal and regulatory due diligence can mean uncovering risks...more

Focusing on “Payments” to Healthcare Professionals (Part I of III)

The Volkov Law Group on 2/6/2019

The United States healthcare industry poses an infinite number of risks when it comes to interactions with healthcare professionals. Given the aggressive regulation and enforcement of prohibitions against kickbacks and...more

OIG Offers Additional Guidance on Gainsharing Arrangement in Advisory Opinion 17-09

Baker Donelson on 2/5/2018

A non-profit acute care hospital may share cost savings for certain spinal surgeries with neurosurgeons in a multi-specialty physician group following approval by the U.S. Department of Health & Human Services, Office of...more

OIG Still Rejects Lab's Free Labeling Services for Dialysis Facilities in Advisory Opinion No. 16-12

Baker Donelson on 12/20/2016

8 Years and New Reimbursement Methodology Later - On November 28, 2016, the U.S. Department of Health and Human Services, Office of Inspector General (OIG) issued an unfavorable advisory opinion, No. 16-12, regarding a...more

Due Diligence Guide for Mergers and New Ventures in a Dynamic Health Care Landscape

Baker Donelson on 10/11/2016

Please see full publication below....more

OIG Gives Green Light to Hospice Provider’s Payment to Nursing Facilities

Mintz - Health Care Viewpoints on 8/1/2016

Last week, the OIG issued a favorable opinion to a hospice provider seeking to make supplemental payments to skilled nursing facilities. Under the proposed arrangement, the hospice provider would make a supplemental payment...more

Yet Again, OIG Approves Medigap Policy Contracts with Preferred Hospital Network

Baker Donelson on 4/11/2016

On March 11, 2016, the U.S. Department of Health & Human Service, Office of the Inspector General (OIG) issued an advisory opinion approving the use of a preferred hospital network as part of Medicare Supplemental Health...more

HealthCare Fraud and Courtesies: What to Know Before Waiving a Copayment

Adler Pollock & Sheehan P.C. on 9/9/2014

Many healthcare facilities and physicians waive the insurance copayment for physicians and their families (known as professional courtesy) or other patients. Yet, despite how prevalent the practice is and the limited...more

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