In my experience, most physician groups rely on the “in-office ancillary service” exception to the Stark Law when determining how to allocate revenues from designated health services among group members. The Stark Law is, of...more
The Centers for Medicare & Medicaid Services (CMS) issued Blanket Waivers of certain requirements of the Physician Self-Referral Law (Stark Law). The purpose for the Blanket Waivers is to provide the flexibility providers...more
The Health and Human Services (HHS) Office of Inspector General (OIG) issued a Policy Statement on March 17, 2020 regarding the waiver of amounts owed by beneficiaries for services provided by telehealth. Recognizing the...more
Congress has activated a new Anti-Kickback law known as Eliminating Kickbacks in Recovery Act of 2018 (commonly referred to as EKRA). The new Anti-Kickback law applies to arrangements involving recovery homes, clinical...more
6/14/2019
/ Anti-Kickback Statute ,
Clinical Laboratories ,
Criminal Prosecution ,
Eliminating Kickbacks in Recovery Act of 2018 (EKRA) ,
Health Care Providers ,
Healthcare Facilities ,
Healthcare Reform ,
Opioid ,
Pharmaceutical Industry ,
Physicians ,
Prescription Drugs ,
Safe Harbors ,
Substance Abuse
A recent Advisory Opinion (Advisory Opinion 18-03) from the Office of Inspector General (OIG) of the Department of Health and Human Services addresses potential kickback issues involved in the donation of telehealth...more
A recent Office of Inspector General (OIG) advisory opinion approved a proposal under which a hospital has established a caregiver center that provides or arranges for free or reduced-cost support services to caregivers in...more
8/30/2018
/ Alternative Fee Arrangements ,
Anti-Kickback Statute ,
Caregivers ,
Civil Monetary Penalty ,
Free Health-Related Services ,
Health Care Providers ,
Inducements ,
Low-Income Issues ,
Medicaid ,
Medicare ,
OIG ,
Remuneration
The Department of Justice (DOJ) recently announced the guilty plea of two individual alcohol and substance abuse treatment center owners for their participation in what the DOJ labeled a “multi-million dollar health care...more
5/24/2018
/ Anti-Kickback Statute ,
Bribery ,
Controlled Substances ,
Criminal Prosecution ,
Department of Justice (DOJ) ,
Drug Treatment ,
Guilty Pleas ,
Health Care Providers ,
Kickbacks ,
Money Laundering ,
Opioid ,
Prescription Drugs ,
White Collar Crimes
One of the reasons compliance officers and health care attorneys read fraud settlements is to identify issues the government is focused on. The cases the government decides to pursue are very indicative of the areas of fraud...more
5/18/2018
/ Anti-Kickback Statute ,
Controlled Substances Act ,
DEA ,
Enforcement Actions ,
False Claims Act (FCA) ,
Health Care Providers ,
Medicare ,
Opioid ,
Patient Referrals ,
Pharmaceutical Industry ,
Prescription Drugs ,
Stark Law ,
Whistleblowers
A relatively recent case involving buy-in terms in an ambulatory surgery center demonstrates how different valuations for referral sources and non-referral sources can be evidence of remuneration under the Medicare...more
The HHS Office of Inspector General offers providers an opportunity to self-disclose certain violations in exchange for avoiding some of the more draconian penalties that may otherwise apply under applicable regulations. ...more
Many surgery centers are eventually faced with decisions about how to treat investing physicians who do not perform as many procedures in the surgery center as others. Under performing physicians can create political issues...more