On Oct. 7, the U.S. Supreme Court denied a petition for review and let stand a widely watched Second Circuit Court of Appeals decision in which the court ruled that the term “willfully” as used in the Anti-Kickback Statute...more
The Supreme Court’s recent ruling in Loper Bright Enterprises v. Raimondo (and its companion case, Relentless v. Department of Commerce), in which it overruled the Chevron doctrine, has received a great deal of attention...more
7/29/2024
/ Administrative Procedure Act ,
Affordable Care Act ,
Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Chevron Deference ,
Civil Rights Act ,
Department of Health and Human Services (HHS) ,
False Claims Act (FCA) ,
Health Care Providers ,
Loper Bright Enterprises v Raimondo ,
Physician Medicare Reimbursements ,
Relentless Inc v US Department of Commerce ,
Sex Discrimination ,
Stark Law ,
Statutory Interpretation
The U.S. Department of Health and Human Services Office of Inspector General (“OIG”) recently considered the question whether an employed physician can be paid bonus compensation relating to procedures performed by the...more
10/26/2023
/ Advisory Opinions ,
Ambulatory Surgery Centers ,
Anti-Kickback Statute ,
Bonuses ,
Compensation ,
Department of Health and Human Services (HHS) ,
Employees ,
Health Care Providers ,
OIG ,
Physicians ,
Remuneration ,
Safe Harbors
Last week, the U.S. Supreme Court denied the request of qui tam relators that it review the Sixth Circuit’s recent decision in United States of America ex rel. Martin v. Hathaway, No. 22-1463 (6th Cir.). In so doing, the...more
10/10/2023
/ Anti-Kickback Statute ,
But For Causation ,
Denial of Certiorari ,
False Claims Act (FCA) ,
Health Care Providers ,
Patient Referrals ,
Physicians ,
Qui Tam ,
Relators ,
Remuneration ,
SCOTUS
On August 18, the Office of Inspector General in the Department of Health and Human Services (“OIG”) issued Advisory Opinion 23-05 in which it concluded that a proposed arrangement involving the formation of a company...more
On the heels of the Sixth Circuit’s recent decision in Martin v. Hathaway, previously discussed on Health Law Observer, a critical issue in that case, i.e., the meaning of the term “remuneration” for purposes of the federal...more
In a prior blog post, we discussed U.S. ex. rel. Shannon Martin, M.D. v. Darren Hathaway, M.D. et al, a Sixth Circuit case involving the questions (1) whether a hospital’s decision not to hire an ophthalmologist (Dr. Martin)...more
Two recently decided federal court cases hone in on the proper interpretation and application of three critical components of the Anti-Kickback Statute (“AKS”), namely:
•the requirement that a violation of the AKS must...more
4/17/2023
/ Affordable Care Act ,
Anti-Kickback Statute ,
Bribery ,
Causation ,
False Claims Act (FCA) ,
Federal Health Care Programs (FHCP) ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Patient Referrals ,
Qui Tam ,
Rebates ,
Remuneration
A recent U.S. District Court decision provides a good example of how federal courts will apply the public disclosure/original source rules in whistleblower cases alleging that health care providers violated the False Claims...more
An important threshold question in qui tam cases under the False Claims Act is whether the relator-whistleblower is the original source of the information forming the basis for the claim. This is because qui tam actions under...more
The Office of Inspector General (“OIG”) in the Department of Health and Human Services has longstanding concerns regarding physician-owned entities that derive revenue from selling items ordered by their physician owners for...more