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Provider Self-Disclosure Decisions – Voluntary Disclosure Process

Posted on November 7, 2016 by

The decision whether or not to voluntarily disclose non-compliance to the government can be very difficult.  Not every case is clear. Clearly not every situation where there has been a billing error amounts to fraud or wrongdoing requiring use of the self-disclosure protocol.  Many overpayments that are identified through audit can be dealt with at […]

When Does An Overpayment Become Fraud? How Simple Inattention Can Expose You to Penalties for Fraudulent Activities

Posted on November 7, 2016 by

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 standpoint, prosecuting fraud and abuse is good business. Every dollar the government puts into pursuing health […]

CMS Releases the First Comprehensive Overhaul of Nursing Home Conditions of Participation in Over 25 Years

Posted on November 2, 2016 by

On October 4, 2016, the Center for Medicare and Medicaid Services (CMS) published a final rule to revise the requirements that Long-Term Care facilities must meet to participate in the Medicare and Medicaid programs. CMS states that the revisions to nursing home regulations are intended to reflect the substantial advances that have been made in […]

Lincoln’s Law Becomes Even More Absurd When Applied to the Health Care Industry

Posted on November 2, 2016 by

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 unscrupulous vendors who provided overpriced and often faulty supplies to the military during the Civil […]

Ambulatory Surgery Center Compliance Federal Settlement Raises Issues for Physician Owned Surgery Centers

Posted on September 30, 2014 by

A Federal Whistleblower that was recently settled in the United States District Court for the Middle District of Tennessee illustrates the difficult issues involved in structuring ambulatory surgery center (“ASC”) investments. Specifically, the case demonstrates how investment terms that are intended to assure compliance with the safe harbor regulations under the Medicare Anti?Kickback Statute (42 […]

The Role of Confidentiality Agreements in a Corporate Compliance Program

Posted on June 26, 2014 by

A recent federal court decision from Pennsylvania illustrates the importance of a confidentiality agreement as part of a compliance program. The Pennsylvania court found that a confidentiality agreement that had been signed by an employee restricted the ability of the whistleblower claimant to use confidential information to support its qui tam claim under the federal […]

Provider Self Disclosure Process

Posted on May 22, 2014 by

A growing area of the health care legal practice involves counseling clients on issues that could require self disclosure under OIG or CMS procedures. The Office of Inspector General has procedures that a provider may follow to disclose possible violations of the Anti-Kickback Statute or other federal laws. Providers have the opportunity to avoid much […]

Jointly Providing Health Care Fee Information to Payors

Posted on May 22, 2014 by

As health care provider networks move down the path toward clinical integration, we are often asked to provide guidance on how information can be jointly provided to payors. The antitrust laws recognize that collective sharing of some pricing information, even by otherwise competing providers, can be beneficial and does not necessarily violate antitrust laws. However, […]

CMS Changes Meaningful Use Timeline

Posted on May 21, 2014 by

The Centers for Medicare and Medicaid Services (CMS) issued a new proposed rule today that changes the timeline for meaningful use electronic health record (EHR) technology. The new proposed rule would be consistent with previous CMS announcement regarding extension of Stage 2 and Stage 3 timelines. The proposed rule recognizes the difficulties that software vendors […]

OIG Proposes New Civil Monetary Penalty Rules

Posted on May 19, 2014 by

On May 12, 2014, the Office of Inspector General (OIG) published a proposed rule that would amend the civil monetary penalty (CMP) rules of the OIG to incorporate new CMP authorities, clarify existing authorities, and reorganize regulations on civil money penalties, assessments, and exclusions. The proposed regulations are intended by the OIG to update regulations […]