On April 10, 2013, President Obama released his proposed federal budget for fiscal year 2014. Buried within the budget is a proposal to limit physician self-referrals for certain ancillary services. Specifically, the budget proposes to encourage what it calls “more appropriate” use of ancillary services by limiting those providers who may self-refer for radiation therapy,… Continue Reading
Category Archives: Fraud and Abuse
Subscribe to Fraud and Abuse RSS FeedSixth Circuit Overturns $11.1 Million Judgment Against MedQuest for FCA Violations
Posted in 6th Circuit, False Claims Act, Fraud and Abuse, Regulatory ComplianceOn April 1, 2013, the United States Court of Appeals for the Sixth Circuit overturned the $11.1 million judgment against MedQuest for its submission of claims to Medicare for tests in diagnostic testing facilities that were not supervised by approved physicians. The whistleblower action was initiated by a former MedQuest employee, alleging that MedQuest, a… Continue Reading
Proposed Rules Issued Extending Protections of Electronic Health Record Donations
Posted in Accountable Care Organizations, Department of Health and Human Services, Electronic Health Records, Fraud and Abuse, Hospitals, Physician Practice, Regulatory ComplianceProposed Rules Issued Extending Protections of Electronic Health Record Donations On April 10, 2013, the Department of Health and Human Services (DHHS), Office of Inspector General (OIG) and the DHHS, Centers for Medicare & Medicaid Services (CMS) each issued a proposed rule relating to the donation of interoperable electronic health records software or information technology… Continue Reading
OIG Issues Special Fraud Alert: Physician-Owned Distributorships (PODs)
Posted in Department of Health and Human Services, Fraud and Abuse, Physician PracticeOIG Issues Special Fraud Alert: Physician-Owned Distributorships (PODs) On March 26, 2013 the Department of Health and Human Services, Office of Inspector General (OIG) issued a Special Fraud Alert: Physician-Owned Entities (Alert). The Alert focuses on the specific attributes and practices of “physician-owned entities that derive revenue from selling, or arranging for the sale of,… Continue Reading
Article Shines Spotlight on Pharma Payments to Physicians
Posted in Fraud and Abuse, Pharmaceutical, Physician PracticeAn article published today in the Columbus Dispatch shines a spotlight on physicians receiving payments from pharmaceutical companies for speaking and consulting engagements. The article identifies several central Ohio physicians who have received hundreds of thousands of dollars in fees from drug companies from 2009 through 2012. The Dispatch’s analysis, taken from data gathered by… Continue Reading
Protecting the Attorney-Client Privilege for In-House Counsel
Posted in Fraud and AbuseThe interplay between attorney-client privilege and in-house counsel communications has been on many people’s minds since the Middle District of Florida’s decision late last year in US ex rel. Baklid-Kunz v. Halifax Hospital Med. Ctr. In that case, the court rejected a hospital’s privilege arguments and required production of hundreds of its in-house counsel and compliance officer’s emails… Continue Reading
$762 Million Settlement by Amgen of Civil, Criminal, and Kickback Claims Approved by Judge
Posted in Fraud and AbuseYesterday, Amgen received approval of a global settlement from the federal judge in New York presiding over the criminal case filed against Amgen by the Department of Justice regarding the off-label promotion of the anemia drug Aranesp. The settlement resolves criminal charges and civil kickback claims filed by the federal government, claims of Medicaid fraud filed by 49 states… Continue Reading
Upcoming Webinar “Addressing Enterprise Risk After the Affordable Care Act”
Posted in Fraud and AbuseOn Thursday, November 15, 2012 at 12:00 Eastern, Squire Sanders, in conjunction with Southwind and Willis Group’s Health Care Practice, will be presenting a free 1-hour webinar on “Addressing Enterprise Risk After the Affordable Care Act” as part of our on-going What Keeps You Up at Night series. View the event webpage for more information or to… Continue Reading
Massachusetts provider settles HIPAA case for $1.5 million
Posted in Department of Health and Human Services, Fraud and AbuseOn September 17, 2012, the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) announced that the Massachusetts Eye and Ear Infirmary and Massachusetts Eye and Ear Associates Inc. (collectively referred to as “MEEI”) agreed to pay $1.5 million to settle potential violations of the Health Insurance Portability and Accountability Act… Continue Reading
A Scary Investigation Ends Well
Posted in Fraud and AbuseShortly before Halloween of last year, a Squire Sanders healthcare client received an omen that all was not well – a Civil Investigative Demand (“CID”) served by the United States Department of Justice (DOJ). Broad, aggressive, and without identifying any pending legal complaint (CIDs usually don’t), the CID made a frighteningly lengthy list of demands… Continue Reading
OIG Solicits Comments Regarding Revision to Self-Disclosure Protocol
Posted in Department of Health and Human Services, Fraud and AbuseOn June 18, the OIG published notice in the Federal Register advising that it is now soliciting information and recommendations for revising its provider self-disclosure protocol. [https://www.federalregister.gov/articles/2012/06/18/2012-14585/solicitation-of-information-and-recommendations-for-revising-oigs-provider-self-disclosure-protocol#p-13] The OIG’s self-disclosure protocol is a mechanism whereby providers may voluntarily disclose self-discovered evidence of potential violations of the Anti-Kickback Statute. Providers utilizing the protocol must disclose a… Continue Reading
GAO Recommends Changing Medicaid Audit Program Due To Poor Results
Posted in Department of Health and Human Services, Fraud and AbuseIt appears that the National Medicaid Audit Program hasn’t been worth the money it cost to run. According to published testimony released by the Government Accountability Office (GAO) today, only 4% of the 1,550 audits, though, resulted in refunds to the government of approximately $7.4 million. More than two-thirds of the audits found no overpayments. The remaining 27%… Continue Reading
Firm Attorneys Author Article: “Rx for Fraud: The Feds Get Personal”
Posted in Fraud and AbuseSquire Sanders lawyers Thomas E. Zeno (Washington DC) and Kimberly J. Donovan (Miami) co-authored the article “Rx for Fraud: The Feds Get Personal,” just published in the Winter 2012 edition of Criminal Justice, a magazine of the American Bar Association. In the ten-page article, Tom and Kimberly discuss the federal government’s expanded tactics for combating… Continue Reading
Two Squire Sanders Attorneys Offer Modern Healthcare Readers Insight on the Antitrust and Fraud and Abuse Implications of the New ACO Final Rule
Posted in Accountable Care Organizations, Fraud and AbuseSquire Sanders attorneys, Chris Gordon, a Principal in the Washington, D.C. office, and Rob Nauman, a Senior Associate in the Columbus, Ohio office, were recently interviewed by Modern Healthcare for their take on the relaxation of the interim final rule on waivers of fraud and abuse laws and the antitrust policy statement on ACOs. Their… Continue Reading
CMS Issues Self-Referral Disclosure Protocol, But Concerns Remain
Posted in Fraud and Abuse, PPACAAs required under The Patient Protection and Affordable Care Act (PPACA), CMS has issued the Self-Referral Disclosure Protocol (SRDP), through which healthcare providers may voluntarily report actual or potential Stark Law violations. While the OIG maintains a voluntary disclosure protocol for suspected violations of the Anti-Kickback Statute and other Federal laws, the SRDP represents CMS’s… Continue Reading