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Opioid Fraud and Abuse as a Compliance Risk Area

Posted on February 20, 2018 by

The opioid epidemic is different than other drug related social problems because, in many cases, addiction to opioids starts in the medical office or in the pharmacy; in most cases through the treatment of legitimate physical pain and often chronic pain.  As such, the marketing practices of companies who manufacture, market, and distribute these highly […]

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

Posted on November 28, 2017 by

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 […]

Inspector General Audit Could Impact Skilled Nursing Facilities

Posted on September 12, 2017 by

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 […]

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

Posted on June 28, 2017 by

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 […]

Medicaid Fraud Control Units Report Focus on Personal Care Services

Posted on June 27, 2017 by

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 […]

Free Parking, Yes, But No Stark Law Claim

Posted on June 21, 2017 by

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 a […]

Reminder: New Voluntary Self-Referral Disclosure Effective June 1

Posted on May 31, 2017 by

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 […]

Lessons from OCR HIPAA Settlements – Mobile Device Security Standards

Posted on May 3, 2017 by

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 disclosed to the Office […]

Repayment and Self Disclosure of Known Overpayments

Posted on May 3, 2017 by

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 […]

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

Posted on May 3, 2017 by

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 […]