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Defining the Duty of the Board of Directors over Compliance Functions

Posted on March 22, 2017 by

I recently posted a blog article about a document released by the Department of Justice entitled “Evaluation of Compliance Programs.”  As the title of the document might suggest, the DOJ release covers a variety of issues it looks at when evaluating the effectiveness of compliance programs.  The document includes some guidance on how a corporate […]

Excluded Party Cases Dominate OIG Published Self Disclosure Settlements

Posted on March 17, 2017 by

In 2013, the HHS Office of Inspector General issued revised protocols outlining the process through which health care providers are able to self-disclose and resolve potential liability under the OIG’s civil monetary penalty (CMP) authorities.  The 2013 Self Disclosure Protocols (SDP) clarified the process of self-disclosure and provided answers to some of the questions previously […]

Physician Practice Compliance Programs

Posted on March 14, 2017 by

In today’s environment of complex regulations, aggressive prosecution, exorbitant penalties, and hungry whistleblower attorneys, it is necessary for medical practices to maintain effective compliance programs.  Failure to do so puts the practice at a great deal of unnecessary risk.  Many or most practices will eventually make errors in their billing and collections or other regulatory […]

Enforcing ASC Exclusion Provisions While Minimizing Legal Risk – Rethinking Strict Application of the Safe Harbors to Exclusion Decisions

Posted on March 3, 2017 by

Many surgery centers are eventually faced with decisions about how to treat investing physicians who do not perform as many procedures in the surgery center as others.  Under performing physicians can create political issues in ASCs because investors who perform more surgeries or higher value procedures at the center feel the other investors are taking […]

Setting Up Your Compliance Internal Reporting Mechanism

Posted on March 3, 2017 by

Recent Changes to Medicare “Incident To” Billing Rules

Posted on March 2, 2017 by

Medicare permits a physician to bill for certain services furnished by a nurse practitioner or other auxiliary personnel under what is referred to as the “incident to” billing rules.  The “incident to” rules permit services or supplies furnished as an integral, although incidental, part of the physician’s personal professional services in the course of diagnosis […]

The Case of the Very Very Impossibly Long, Terrible, Horrible, No Good, Very Bad Day

Posted on February 28, 2017 by

How Fraud and Abuse Cases Arise in a Medical Practice It is no secret many doctors work very long days.  Some days are worse and some are better than others.  As a compliance lawyer, my job is to attempt to prevent doctors from having Terrible, Horrible, No Good, Very Bad Days.  In my experience, this […]

Chiropractic Service Overpayment for Lack of Medical Necessity

Posted on February 27, 2017 by

Recent OIG Release Emphasizes Need for Compliance Policies Specific to Provider Risks The Office of Inspector General recently published results of its audit of Medicare claims for chiropractic services made by a chiropractic group in Kansas.  The review concluded the groups received over $725,000.00 in overpayments in calendar years 2011 and 2012. In its report, […]

Department of Justice Issues Principles of an Effective Compliance Program

Posted on February 23, 2017 by

The Department of Justice issued a directive entitled “Evaluation of Corporate Compliance Programs.”  The document provides insight into the analysis used by the DOJ to assess the effectiveness of a corporate compliance program when making sentencing recommendations under the United States Sentencing Guidelines. The document references the Principles of Federal Prosecution of Business Organizations included […]

House Republicans and Trump Administration File Joint Motion to Delay Suit Challenging Obamacare Subsidies

Posted on February 23, 2017 by

An interesting development transpired Tuesday, February 21, 2017 in a case pending in Federal District Court in the District of Columbia that challenges subsidy payments from the Federal Treasury to support Obamacare.  The case was originally filed by House Republicans in 2014 challenging the constitutionality of the Obama administration’s authorization and payment of funds from […]