Posted on May 28, 2019 by Ruder Ware Alumni
Blog
The Department of Justice (DOJ) along with other health care fraud enforcement agencies, continue to send strong signals that they want businesses to police themselves for potential compliance issues and self-disclose where infractions are found. The fact of the matter is the government simply does not have enough resources to track down and take action […]
Posted on May 17, 2018 by Ruder Ware Alumni
Blog
One of the reasons compliance officers and health care attorneys read fraud settlements is to identify issues the government is focused on. The cases the government decides to pursue are very indicative of the areas of fraud enforcement they feel are important. These are not the only issues that should be considered, but government enforcement […]
Posted on November 28, 2017 by Ruder Ware Alumni
Blog
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 […]
Posted on May 3, 2017 by Ruder Ware Alumni
Blog
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 […]
Posted on April 5, 2017 by Ruder Ware Alumni
Blog
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 […]
Posted on February 28, 2017 by Ruder Ware Alumni
Blog
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 […]
Posted on November 7, 2016 by Ruder Ware Alumni
Blog
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 […]
Posted on November 2, 2016 by Ruder Ware Alumni
Blog
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 […]
Posted on June 26, 2014 by Ruder Ware Alumni
Blog
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 […]