News & Analysis as of November 15, 2024

Fair Market Value

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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 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 -

Investigations Newsletter: FCA Enforcement & Compliance Digest — Summer 2024 False Claims Act Newsletter

ArentFox Schiff on 7/31/2024

Welcome to the Summer 2024 issue of “FCA Enforcement & Compliance Digest,” our quarterly newsletter in which we compile essential updates on False Claims Act (FCA) enforcement trends, litigation, agency guidance, and...more

Now is Not the Time to Relax: Record Settlements in Stark Law and False Claims Cases

Lathrop GPM on 6/4/2024

In early May 2024, the University of Pittsburgh Medical Center (UPMC) agreed to pay $38 million to resolve a False Claims Act case based on alleged Stark Law violations. The size of the settlement in United States ex rel. J....more

Ep. 12 - Working with Valuation Experts to Substantiate Fair Market Value Compensation

Dentons on 4/26/2024

We often work with valuation experts to ensure compensation payments between healthcare organizations and physicians are fair market value and commercially reasonable for purposes of compliance with the Stark Law and the...more

Client Update – New OIG General Compliance Guidance Released

Chambliss, Bahner & Stophel, P.C. on 11/29/2023

November 28, 2023 | Legal Update On November 10, 2023, the Office of the Inspector General (OIG) released its widely anticipated General Compliance Program Guidance (GCPG). The OIG had previously announced that it would...more

Is Fair Market Value Dispositive in an Anti-Kickback Statute Case?

Stevens & Lee on 6/22/2023

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

Federal Case Details How a Relator-Whistleblower Satisfies the False Claims Act’s “Original Source” Requirement

Stevens & Lee on 1/4/2023

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

[Webinar] Updates on Stark Regulations and Impacts on Fair Market Value/Commercial Reasonableness - June 28th, 12:00 pm - 1:30 pm...

Health Care Compliance Association (HCCA) on 6/3/2022

Learning Objectives: - Impact 2021 Physician Fee Schedule has had/will have on Physician Compensation and Benchmark Data - Impact COVID has had/will have on Physician Compensation - Evolution of Use of Benchmark Data,...more

2021 Recap: Hospitals’ Significant False Claims Act Settlements

Bass, Berry & Sims PLC on 1/24/2022

Each year, the Department of Justice (DOJ) recovers millions of dollars through False Claims Act (FCA) settlements, and 2021 was no exception. Some of the most sizeable or otherwise noteworthy settlements from 2021 were with...more

Fraud and abuse risks in digital health: What tech companies need to know about healthcare enforcement – Part II

White & Case LLP on 2/10/2021

For companies looking to monetize their hard-earned innovations in digital health, there is a minefield of potential healthcare enforcement to avoid. As discussed in Part I of this alert, such healthcare enforcement can lead...more

CMS Finalizes and Clarifies Key Valuation Terms in the Stark Law

Jones Day on 1/20/2021

The Situation: Under the federal Physician Self-Referral Law ("Stark Law"), many physician arrangements must meet one or more of the so-called "big three" requirements: that the arrangement be "commercially reasonable," that...more

OIG Takes Aim at Speaker Programs in Special Fraud Alert

Bradley Arant Boult Cummings LLP on 11/20/2020

On November 16, 2020, the Office of Inspector General of the Department of Health and Human Services (OIG) issued a Special Fraud Alert addressing the fraud and abuse risks of speaker programs that are commonplace in the...more

Acute Care Hospital Agrees to Pay $50 Million to Settle Alleged Stark Law and Anti-Kickback Statute Violations

ArentFox Schiff on 9/14/2020

Acute Care Hospital Agrees to Pay $50 Million to Settle Alleged Stark Law and Anti-Kickback Statute Violations - On September 9, 2020, the Department of Justice (“DOJ”) announced that Wheeling Hospital Inc. (“Wheeling...more

CMS proposes changes to and clarifications of key Stark Law terms

Bricker Graydon LLP on 10/17/2019

Part of the Centers for Medicare and Medicaid Services’ (CMS) proposed changes “to modernize and clarify” regulations interpreting the Physician Self-Referral Law (the “Stark Law”), released on October 9, 2019, contain...more

Remuneration? Not If It’s Fair Market Value, Says Eleventh Circuit

McDermott Will & Emery on 9/18/2019

Bingham v. HCA, Inc., a recent Eleventh Circuit case, highlights the centrality of fair market value to Anti-Kickback Statute (AKS) analyses. This decision is significant for several reasons and we expect to see Bingham cited...more

Skeletons in the Closet? Beware of Potential Enforcement Actions

Mintz - Health Care Viewpoints on 10/29/2015

With Halloween looming, a discussion of skeletons that may be lurking in a health care provider’s closet is timely. Many of our previous posts, as well as the monthly Qui Tam Updates published by our Health Care Enforcement...more

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