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Showing 16 posts in Fraud & Abuse.

HHS Office for Civil Rights Publishes Checklist for HIPAA Covered Entities Responding to Cybersecurity Incidents

The U.S. Department of Health and Human Service's Office for Civil Rights ("OCR") recently published guidance for entities covered by HIPAA, entitled "My entity just experienced a cyber-attack! What do we do now?" Read More ›

Categories: Cybersecurity, Digital Assets, Electronic Health Records, Fraud & Abuse, HIPAA

DOJ Memo: Corporate Investigations to Focus on Individual Accountability

corporate investigationsRecent guidance issued by the U.S. Department of Justice (“DOJ”) reveals the government’s renewed focus on individual accountability during corporate investigations. On September 9, 2015, Deputy U.S. Attorney General Sally Quillian Yates issued a memorandum to DOJ attorneys (the “Yates Memo”) that emphasizes the importance of seeking accountability from the individuals who are responsible for corporate wrongdoing.

The Yates Memo outlines six measures that should be taken by federal prosecutors during any investigation of corporate misconduct in order to hold accountable the individuals who are responsible for the conduct. A discussion of each measure appears below. Read More ›

Categories: Fraud & Abuse, Providers

Government Intervenes in Affordable Care Act 60 day Rule Violation Allegation

Government Intervenes in Affordable Care Act 60 day Rule Violation AllegationIn a first-of-its-kind and closely followed case, a U.S. district court denied a New York health system's (Healthfirst’s) motion to dismiss the U.S. government's and State of New York's complaints in intervention under the federal False Claims Act (FCA) and New York state counterpart. This case represents the first time that the government has intervened in an FCA case based upon an allegation that a party violated the "60 day rule." The 60 day rule came into existence with the passage of the Affordable Care Act (ACA) in 2010 and subjects parties to FCA liability for failing to report and refund an overpayment within 60 days of identification, even if the defendant received the payment through no fault of its own.

The case, Kane ex rel. United States et al. v. Healthfirst et al., involves three hospitals that were part of the Healthfirst health system network and provided care to patients that were part of Healthfirst's Medicaid managed care plan. Healthfirst received payments from the New York State Department of Health (DOH) in return for services provided to Medicaid eligible enrollees.

The government's allegations stem from overpayments to Healthfirst as a result of a software glitch. Healthfirst was first questioned about the possible overpayments by the New York State Comptroller's office in 2010. The health system tasked Kane, an employee and the eventual whistleblower in the case, to look into the payments. Five months later Kane emailed Healthfirst management a spreadsheet listing over 900 claims totaling more than $1 million that contained an erroneous billing code that may have led to the overpayments. Read More ›

Categories: Billing/Payment, Fraud & Abuse, Health Care Reform, Hospitals, Medicare/Medicaid, News & Events, Providers

Michigan Doctor Sentenced to 45 Years for Cancer Fraud Scheme

Dr. Farid Fata was sentenced to 45 years in a federal prison by U.S. District Judge Paul Borman. The sentence was greater than the 25 years that the defense advocated for, but well under the 175-year maximum requested by the prosecution. Dr. Fata, who had built an empire of upscale cancer clinics, intentionally misdiagnosed patients and illegally billed Medicare for the treatment. He grossly over-treated, under-treated, and misdiagnosed hundreds of patients by telling them they had cancer when they did not, giving too much or improper treatment to others who did have cancer, and continuing to give chemotherapy to terminal patients who no longer needed it.  Read More ›

Categories: Fraud & Abuse, News & Events

Recap from the 2015 Health Law Institute

Recap from the 2015 Health Law InstituteFoster Swift health care attorneys recently attended and presented at the 21st Annual Health Law Institute on March 12 and 13, 2015. The two-day institute, which was co-sponsored by the Institute for Continuing Legal Education and the Health Care Law Section of the State Bar of Michigan, included presentations on recent statutory, regulatory, and case law developments in the health care industry.

Foster Swift Attorney Jennifer Van Regenmorter co-presented the “Michigan Health Law Update,” which provided an overview of Michigan’s most significant health law developments from the past year. This was Van Regenmorter’s third time presenting this yearly update at the Institute. Read More ›

Categories: Fraud & Abuse, HIPAA, News & Events, Physicians

“Top 10 Healthcare Law Trends in 2015” – Part 1

healthcare law trends

The February issue of the American Health Lawyers Association’s AHLA Connections features a top-ten list of the issues that will impact healthcare law in 2015. This two-part series discusses these important trends.

Here are the first five: Read More ›

Categories: Fraud & Abuse, Health Care Reform, Medicare/Medicaid, News & Events

OIG Issues Special Fraud Alert on Clinical Laboratory Payments to Physicians

clinical laboratory paymentsThe Office of the Inspector General for the United States Department of Health and Human Services (the “OIG”) recently issued a Special Fraud Alert regarding laboratory payments to referring physicians (the “Alert”). The Alert relates to two types of compensation arrangements - Specimen Processing Arrangements and Registry Arrangements - between clinical laboratories and physicians who order clinical laboratory tests that the OIG believes present a substantial risk of fraud and abuse under the federal anti-kickback statute. Read More ›

Categories: Compliance, Fraud & Abuse, Physicians

Cracking Down on Fraud and Waste: OIG Releases Recommendations to Increase HHS Program Efficiency

hhs programIn March of 2014, the Office of the Inspector General ("OIG") released the "OIG Compendium of Priority Recommendations." The recommendations offered are designed to help current programs for the Department of Health and Human Services ("HHS") run more effectively. The recommendation discussed twenty-five "opportunities" which, if addressed, would help to eliminate fraud and waste among HHS programs. The “opportunities” include the following: Read More ›

Categories: Compliance, Fraud & Abuse, Medicare/Medicaid, Providers

Omnicare Settles Whistleblower Lawsuit Alleging Kickback Scheme With Nursing Homes

Omnicare Inc., the nation's largest dispenser of prescription drugs in nursing homes, announced on October 23, 2013, that it has agreed to pay $120 million to settle a whistleblower lawsuit alleging kickbacks to nursing homes.

The whistleblower in the case, an Ohio pharmacist named Donald Gale, worked for Omnicare from 1993 until 2010. The lawsuit, filed in federal court in Cleveland in 2010, accused Omnicare of giving discounts for prescription drugs to nursing homes for certain Medicare patients in return for referrals of other patients at higher prices paid for by the federal government. Read More ›

Categories: Billing/Payment, Fraud & Abuse, Long Term Care, Medicare/Medicaid, Pharmacy, Providers

Health Care Providers Face Steep Penalties for Medicare/Medicaid Fraud

medicare fraudSo far, July has been a busy month for health care fraud enforcement across the country.

On July 18, Divyesh Patel, owner of Alpine Nursing Care Inc. in North Randall, Ohio, was sentenced to two years in prison after pleading guilty to one count of conspiracy to commit health care fraud and four counts of health care fraud. Patel was also ordered to pay total restitution of $1,939,864 to the Medicaid Program in Ohio. According to court documents, Patel hired Belita Mable Bush as the office manager despite knowing that Bush had been convicted of a health care-related felony and excluded from involvement in billing federal health care programs. From June 1, 2006 to October 18, 2009, Patel conspired with Bush to defraud Medicaid by billing for services that had never been performed or that had been performed by excluded individuals. The conspiracy resulted in losses of approximately $1.9 million to the Medicare and Medicaid programs. Bush was convicted on similar charges and will be sentenced next month. Read about more cases ›

Categories: Fraud & Abuse, Health Care Reform, Hospitals, Long Term Care, Medicare/Medicaid, Physicians