Hospice Insights Podcast: What’s the Latest on UPICs? Highlights from Recent Audit Activity, Part I
Hospice Insights Podcast - Stories of Successful Hospice Leadership: The CEO and Chief Medical Officer Relationship
Hospice Insights Podcast - A Rise in Medicare Deactivations: Tips for Avoiding This Financial Pain
AGG Talks: Home Health & Hospice Podcast - Episode 5: Understanding Palliative Care: Strategies for Compliance and Reimbursement
Hospice Insights: Check the Mail: Are You Getting a 4% Rate Cut?
Hospice Labor and Employment Trends - Get Up to Speed Fast: What You Need to Know About the New Rules Involving Non-Competes and Exempt Employees
AGG Talks: Home Health & Hospice - Lessons Learned From ALJ Hospice Audit Appeals
Hospice Insights Podcast - A Refresh: What’s New in the New OIG General Compliance Program Guidance
Hospice Insights Podcast - Deal Breakers: Identifying Key Issues Early in Member Substitutions
A Command Performant(s): RAC Audits on the Rise
The TPE Carousel. . . Around and Around We Go
A Fond Farewell: Musings on the End of the Medicare Advantage Hospice Carve-In Demonstration
OMG. . .The OIG is at it Again
How One Hospice Owner Got Convicted of Healthcare Fraud and How You Can Avoid That Fate
Hospice and Home Health Survey Perspectives: A Conversation with Kim Skehan, VP of Accreditation at CHAP
Year in Review: Key Regulatory Updates in 2023
An Alternative to Consolidations: Key Considerations for Management Services Organizations
Stories of Successful Hospice Leadership: The CEO and Compliance Officer Relationship
A Very “Special” Episode: Amid Controversy, CMS Launches the Hospice Special Focus Program
Grace from CMS: Unexpected Good News on HIS and CAHPS Appeals
Gentiva, the renamed former Kindred at Home, agreed to pay $19.4 million to resolve claims that its predecessor company, Kindred at Home and related companies, violated the False Claims Act by retaining overpayments for...more
Big Baby’s Big Foul: Former NBA Star Glen 'Big Baby' Davis Sentenced to 40 Months for Healthcare Fraud Scheme - On May 9, former Boston Celtics forward Glen “Big Baby” Davis was sentenced to 40 months in prison following...more
Introduction - Polsinelli proudly introduces the Health Care Fraud and Abuse 2023 Year in Review, a comprehensive examination of the evolving landscape surrounding the False Claims Act (“FCA”) and fraud & abuse enforcement...more
News Briefs - State AGs Urge Congress to Reform Pharmacy Benefit Managers - A bipartisan group of 39 state attorneys general sent a letter to Congress urging lawmakers to take "decisive action" to reform pharmacy benefit...more
A New Jersey hospice provider must continue its long fight against whistleblowers alleging it violated the False Claims Act (“FCA”) by seeking Medicare reimbursement for patients whose documentation did not support hospice...more
On February 7, 2023, the Department of Justice (DOJ) announced its annual False Claims Act (FCA) recoveries for fiscal year 2022. DOJ recovered $2.2 billion from a total of 351 settlements and judgments—the second-highest...more
Hear directly from the enforcement community - Want to gain insight into properly monitoring, detecting, investigating, and managing violations? Join us virtually at HCCA’s Annual Healthcare Enforcement Compliance...more
On March 24, the U.S. Court of Appeals for the Fifth Circuit affirmed the criminal healthcare fraud convictions of two individuals who ran a network of home health and hospice centers in Texas. According to the Fifth Circuit,...more
In this third episode of the Husch Blackwell Hospice Team’s “Hospice and the False Claims Act” series, Meg Pekarske, Bryan Nowicki, Jody Rudman and Brian Flood discuss the process and path of a False Claims Act (FCA) lawsuit....more
Episode three of McGuireWoods’ video series “Healthcare Headlines” focuses on trends in False Claims Act investigations across the healthcare industry. Host Amber McGraw Walsh, chair of the firm’s nationally recognized...more
Supreme Court Declines to Review Issue of “Objective Falsity” Under False Claims Act - On February 22, 2021, the United States Supreme Court denied petitions for certiorari in a case that could have addressed the issue of...more
The US Department of Health and Human Services Office of Inspector General (OIG) recently issued important updates to its Anti-Kickback Statute (AKS) safe harbor rules that provide additional legal protections and...more
The AseraCare court decision benefited hospices and physicians, particularly by recognizing the uncertainty surrounding prognostication of a six-month life expectancy and the principle that two physicians can disagree about...more
Last week, the United States Court of Appeals for the Third Circuit held that prognoses of terminal illness submitted in support of hospice claims for reimbursement could be actionable false statements under the False Claims...more
On March 4, 2020, the Third Circuit Court of Appeals held in United States ex rel. Druding v. Care Alternatives, No. 18-3298, 2020 U.S. App. LEXIS 6795 (3d Cir. Mar. 4, 2020) that a difference of opinion between a medical...more
Report on Medicare Compliance 29, no. 9 (March 9, 2020) - The U.S. Attorney’s Office for the District of Massachusetts said March 5 it has filed a False Claims Act complaint against SpineFrontier Inc., Impartial Medical...more
The U.S. Department of Justice (DOJ) has reached a settlement with hospice company AseraCare, closing a 12-year-old saga that carries substantial implications for False Claims Act (FCA) enforcement in cases involving a...more
In the Care Alternatives False Claims Act (FCA) appeal, a panel of the US Court of Appeals for the Third Circuit on March 4 reversed the summary judgment granted to hospice provider Care Alternatives at the district court,...more
On Thursday, AseraCare, a national hospice care provider, announced that it had settled a long-standing Medicare billing dispute with the DOJ, a case that has garnered nationwide attention in healthcare since 2008. At issue...more
Bass, Berry & Sims is pleased to announce the release of the 2019 edition of its Healthcare Fraud & Abuse Annual Review. Compiled by the firm’s Healthcare Fraud Task Force, the Review is an in-depth and comprehensive analysis...more
$3 billion recovered under the False Claims Act (“FCA”). That’s what the US Department of Justice (“DOJ”) reported collecting in FY2019. The health care and life sciences industries accounted for $2.6 billion of the total...more
• Reasonable disagreement among clinicians, by itself, does not result in a false claim. • Clinical judgment must be objectively false to constitute an FCA violation. • A clinical judgment may only be objectively false...more
On September 9, 2019, the U.S. Court of Appeals for the Eleventh Circuit issued its much anticipated decision in United States v. AseraCare Inc., et al., Case No. 16-13004 (11th Cir. Sept. 9, 2019), agreeing with the lower...more
A new federal court decision offers a ray of light to those providers defending false claims actions based on an alleged lack of medical necessity. On September 9, 2019, the United States Court of Appeals for the Eleventh...more
On September 9, in a setback for AseraCare but an overall win for hospice providers, the Eleventh Circuit affirmed a Northern District of Alabama decision to grant a new trial in a False Claims Act (FCA) case against...more