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

Posted on April 11, 2017 by

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 sources can foreclose reliance on safe harbor […]

Can Overpayments Create Criminal Liability?

Posted on April 11, 2017 by

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 […]

Legal and Compliance Issues Impacting Medical Practices Using Laser Technology

Posted on April 7, 2017 by

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 Operation. All medical […]

Disputing Inaccurate Reports Under the Physician Payment Sunshine Act

Posted on April 6, 2017 by

The Affordable Care Act added the Physician Payment Sunshine Act (Sunshine Act) as section 1128G to the Social Security Act. The Sunshine Act requires applicable manufacturers of drugs, devices, biologicals, or medical supplies and certain group purchasing organizations to report annually to the Centers for Medicare & Medicaid Services (CMS) certain payments or items of […]

Attorney Melissa Kampmann Joins The American College of Trust and Estate Counsel As Fellow

Posted on April 6, 2017

Ruder Ware is pleased to announce that Melissa Kampmann has become a Fellow with The American College of Trust and Estate Counsel. The American College of Trust and Estate Counsel is a nonprofit association of lawyers and law professors skilled and experienced in the preparation of wills and trusts; estate planning; and probate procedure and […]

New Safe Harbor Permits Some Free Transportation to Patients

Posted on April 6, 2017 by

A new safe harbor was recently issued by the Health and Human Services (HHS) Office of Inspector General (OIG) that permits eligible health care providers to offer free or discounted transportation to established patients.  The safe harbor addresses concerns that offering free goods and/or services to patients might be considered payment of illegal “remuneration” in […]

EPA’s Risk Management Plan (RMP) Final Rule Delayed

Posted on April 6, 2017 by

EPA’s new Risk Management Plan (“RMP”) Final Rule was to take effect on March 14, 2017.  EPA has delayed the effective date until June 19, 2017, and has proposed a further delay until February 19, 2019, in light of industry petitions for reconsideration and judicial review. On February 28, 2017, the “RMP Coalition” filed its […]

Sally Yates was Already Famous for Changing the Focus of Compliance Investigations – The Yates Memorandum

Posted on April 5, 2017 by

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 before her refusal to defend the immigration ban.  She was the author of the famous […]

Exercising Reasonable Care to Identify and Address Potential Overpayments

Posted on April 5, 2017 by

When the Center for Medicare and Medicaid Services (CMS) finally issued final regulations under the 60-day repayment rule, it implemented a new standard requiring a provider to affirmatively exercise reasonable diligence to identify potential overpayments.  This was a change from the proposed regulations that held providers to a much lower affirmative duty to exercise diligence […]

Three Recent Fraud Cases Involving Dermatologists Illustrate Primary Compliance Risks in Dermatology Practices

Posted on April 5, 2017 by

Three relatively recent cases involving dermatology billing practices illustrate some of the main compliance risks faced by dermatology practices.  These risk areas include: Improper use of multiple removal CPT codes; Billing for “impossibly long days”; Failure to follow supervisions rules required to permit “incident to” billing; Creating incentives for overutilization; and Performing “outlier” levels of […]