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Health Care

  • Federal Government Will Seek Dismissal of False Claims Act Cases That Lack Merit

    Posted on November 28, 2017, Authored by Robert J. Reinertson, Filed under Health Care

    A top official in the U.S. Department of Justice (DOJ) recently announced a major change in the federal government’s position on claims brought under the False Claims Act (FCA).  Michael Granston, the director of DOJ’s Civil Frauds Section, the section that handles health care fraud and other FCA cases, stated that the DOJ will ask the court to dis…   

  • Inspector General Audit Could Impact Skilled Nursing Facilities

    Posted on September 12, 2017, Authored by Robert J. Reinertson, Filed under Health Care

    Skilled nursing facilities (SNF) may see even more scrutiny from the Centers of Medicare and Medicaid Services (CMS) because of a recent audit conducted by the Office of Inspector General of the U.S. Department of Health and Human Services.  The audit looked into abuse and neglect of Medicare recipients residing in SNFs and the associated oversight…   

  • Antitrust Challenge to Narrow Network Products – 7th Circuit Rules in Favor of Exclusive Agreement

    Posted on June 28, 2017, Authored by John H. Fisher, II, Filed under Health Care

    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 reduce the cost of care.  Traditionally, health care plans have been able to manipulate risk through exclusion of pre-existing…   

  • Medicaid Fraud Control Units Report Focus on Personal Care Services

    Posted on June 27, 2017, Authored by John H. Fisher, II, Filed under Health Care

    The Department of Health and Human Services (HHS) Office of Inspector General (OIG) has released a report summarizing activities of State Medicaid Fraud Control Units (MFCUs or Units) for fiscal year 2016.  The OIG is the designated Federal agency for oversight of state MFCUs.  The report found a total of 1,564 convictions of which approximately on…   

  • Free Parking, Yes, But No Stark Law Claim

    Posted on June 21, 2017, Authored by Robert J. Reinertson, Filed under Health Care

    A federal court recently dealt a victory to a health care provider over whistleblower allegations that free parking and valet service at a medical office building violated the Stark Law and the Anti-Kickback Statute.  In Bingham v. BayCare Health System (No. 8:14-cv-73, M.D. Fla.), a federal district judge adopted the report and recommendation of …   

  • Reminder: New Voluntary Self-Referral Disclosure Effective June 1

    Posted on May 31, 2017, Authored by Emilu E. C. Starck, Filed under Health Care

    As discussed in a previous blog, beginning on June 1, 2017, health care providers of services and suppliers wanting to voluntarily disclose actual or potential violations of the Stark Law must follow a new process finalized by CMS.  Previously, health care providers and suppliers were able to submit a self-disclosure of an actual or potential Stark…   

  • Lessons from OCR HIPAA Settlements - Mobile Device Security Standards

    Posted on May 3, 2017, Authored by John H. Fisher, II, Filed under Health Care

    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).  The company provides remote mobile monitoring of and rapid response to patients at risk for cardiac arrhythmias.  The company…   

  • Repayment and Self Disclosure of Known Overpayments

    Posted on May 3, 2017, Authored by John H. Fisher, II, Filed under Health Care

    Timeframes for Making Repayment to the Government 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 or if a self-disclosure is not filed within 60 days after identification…   

  • OCR Settlement Lessons - Failing to Perform an Electronic Access Risk Analysis Before an Unauthorized Access Occurs

    Posted on May 3, 2017, Authored by John H. Fisher, II, Filed under Health Care

    Failure to conduct a risk assessment before a hacking incident occurred resulted in a $400,000 settlement between the Office of Civil Rights (OCR) and a Federally Qualified Health Clinic (FQHC).  The FQHC filed a breach report upon learning its employee emails had been hacked and the hacker had access to electronic health information of over 3,000 …   

  • Suggested Questions for the Compliance Officer

    Posted on April 19, 2017, Authored by John H. Fisher, II, Filed under Health Care

    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 their oversight responsibility, assess the compliance officer, and further their understanding of the compliance program and ri…   

  • Exercising Board Oversight of the Compliance Function

    Posted on April 19, 2017, Authored by John H. Fisher, II, Filed under Health Care

    How the Board can Enhance Compliance Effectiveness 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 Boards is limited to receiving occasional updates from the compliance o…   

  • Self-Disclosure Has Become a Normal Part of the Compliance Process

    Posted on April 12, 2017, Authored by John H. Fisher, II, Filed under Health Care

    As the Office of the Inspector General and Centers for Medicare & Medicaid Services make self-disclosure easier for providers, we have noticed an increase in the rate of cases that are being filed.  Assisting providers in making decisions whether to self-disclose, conducting internal investigations, and guiding the self-disclosure process when …   

  • Ambulatory Surgery Center (ASC) Case Demonstrates Differential Value Theory of Remuneration

    Posted on April 11, 2017, Authored by John H. Fisher, II, Filed under Health Care

    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 Anti-Kickback Statute (42 U.S.C. § 1320a-7b(a)-(b)).  The case also demonstrates how the initial investment terms that favor referral s…   

  • Can Overpayments Create Criminal Liability?

    Posted on April 11, 2017, Authored by John H. Fisher, II, Filed under Health Care

    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 for retaining known overpayments.  Section 1128B(a)(3) of the Social Security Act (42 U.S.C. § 1320a-7b(a)(3)) makes it a cr…   

  • Legal and Compliance Issues Impacting Medical Practices Using Laser Technology

    Posted on April 7, 2017, Authored by John H. Fisher, II, Filed under Health Care

    Medical practices that routinely use laser technology are subject to some of the same legal issues as other types of practices. Use of lasers creates additional compliance issues and highlights certain compliance risk areas. Our special coverage issue contains articles on some of the legal issues impacting these practices. • Compliance Program Ope…   

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