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
This may not be obvious to people who do not keep track of the Federal Trade Commission (FTC)/Department of Justice antitrust enforcement policy, but an enforcement action has never been published involving an Accountable...more
6/21/2018
/ ACOs ,
Anti-Competitive ,
Antitrust Division ,
Department of Justice (DOJ) ,
Enforcement Actions ,
Federal Trade Commission (FTC) ,
Health Care Providers ,
Market-Sharing ,
Proposed Regulation ,
Risk Management ,
Rural Areas
As health care attorneys we are often called upon to consider the antitrust implications in a variety of contracts and transactions. For example, the establishment of clinically integrated health care networks requires...more
6/6/2018
/ Antitrust Provisions ,
Competition ,
Department of Justice (DOJ) ,
Federal Trade Commission (FTC) ,
Health Care Providers ,
Healthcare ,
Hospital Mergers ,
Hospitals ,
No-Poaching ,
Price-Fixing ,
Trump Administration
The state of Michigan has enacted a number of separate pieces of legislation to address the opioid epidemic. Most of these laws are directed at controlling the prescribing relationship between a physician and a patient....more
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
At a recent Health Care Compliance Association (HCCA) compliance institute, the Office of Inspector General announced it had launched a new resource portal focused on compliance issues. A trip to the OIG's web site, and sure...more
We are often asked to advise clients regarding the scope and content of Health Insurance Portability and Accountability (HIPAA) policies and procedures that are required to be maintained. HIPAA clearly requires health care...more
If you navigate to the American Hospital Association (AHA) Interactive Town Hall of January 17, 2018, you can view a video in which Seema Verma, the current Administrator of the Centers for Medicare and Medicaid Services,...more
The opioid epidemic is different than other drug related social problems because, in many cases, addiction to opioids starts in the medical office or in the pharmacy; in most cases through the treatment of legitimate physical...more
The health care market has recently seen a resurgence in narrow network products. To a significant degree, the resurgence of these products has been driven by the need for managed care plans looking for new avenues to help...more
The 60-day repayment rule adopted as part of the Affordable Care Act is a very strong arrow in the quiver of federal enforcement agencies. Under the 60-day rule a known overpayment can become a False Claim if it is not repaid...more
In the first known case involving a wireless provider, a cardiology service provider agreed to pay a $2.5 million settlement based on the impermissible disclosure of unsecured electronic protected health information (ePHI)....more
5/4/2017
/ Data Breach ,
Data Security ,
Electronic Protected Health Information (ePHI) ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Laptop Computers ,
Mobile Devices ,
OCR ,
Risk Assessment ,
Risk Mitigation ,
Security Standards ,
Settlement
In a previous blog post, I promised to release a list of questions a Board of Directors (Board) might ask its compliance officer. This post is intended to fulfill that promise. My intent is to help Board members exercise...more
The Board of Directors (Board) of an organization has oversight responsibilities over the compliance program. Board members are often unsure of the nature and scope of their responsibilities over compliance. The roll of many...more
We hear a lot about potential liability under the False Claims Act (FCA) for the failure to repay overpayments within 60 days of discovery. Focus on the 60-day rule has taken focus away from the potential for criminal charges...more
4/14/2017
/ 60-Day Rule ,
Criminal Penalties ,
Criminal Prosecution ,
False Claims Act (FCA) ,
Federal Criminal False Claims Statute ,
Felonies ,
Health Care Providers ,
Overpayment ,
Overpayment Recovery Time Limits ,
Provider Self-Disclosure Protocol ,
Yates Memorandum
By now the whole world knows about Sally Yates. We are likely to see a lot more of her as a central figure in Congressional investigations. For some of us who deal with compliance investigations, Sally Yates was famous long...more
4/6/2017
/ Bribery ,
Compliance ,
Cooperation ,
Corporate Misconduct ,
Criminal Prosecution ,
Department of Justice (DOJ) ,
Federal Pilot Programs ,
Federal Sentencing Guidelines ,
Foreign Corrupt Practices Act (FCPA) ,
Health Care Providers ,
Individual Accountability ,
Internal Investigations ,
Remediation ,
Self-Disclosure Requirements ,
Voluntary Disclosure ,
White Collar Crimes ,
Yates Memorandum
You have adopted your basic compliance policies and procedures, established a reporting system and visibly rolled out your new compliance program. Your board of directors has passed a resolution decisively stating its...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
In 2013, the HHS Office of Inspector General issued revised protocols outlining the process through which health care providers are able to self-disclose and resolve potential liability under the OIG’s civil monetary penalty...more
3/21/2017
/ Civil Monetary Penalty ,
Department of Health and Human Services (HHS) ,
Exclusion List ,
Federal Health Care Programs (FHCP) ,
Health Care Providers ,
Medicaid ,
Medicare ,
Medicare Billing Privileges ,
OIG ,
Provider Self-Disclosure Protocol ,
Settlement
In today’s environment of complex regulations, aggressive prosecution, exorbitant penalties, and hungry whistleblower attorneys, it is necessary for medical practices to maintain effective compliance programs. Failure to do...more
Medicare permits a physician to bill for certain services furnished by a nurse practitioner or other auxiliary personnel under what is referred to as the "incident to" billing rules. The "incident to" rules permit services...more
On January 13, 2017, the Centers for Medicare & Medicaid Services (CMS) issued Recommendations to Providers Regarding Cyber Security. In general, the Recommendations are intended to remind providers and suppliers to keep...more
If you are involved in any way in the health care system, it should be obvious by now that the government has committed ever increasing resources to the prosecution of fraud and abuse cases. Simply put, from a governmental...more
When Congress originally passed the False Claims Act (31 USC §§ 3729-3733), no one had the health care system in mind. The False Claims Act was also commonly referred to as the “Lincoln Law”. The original law was focused on...more