Fox Rothschild LLP partner, William Maruca, was recently interviewed for an article in Cosmos regarding the regulatory risks to hospitals and DME suppliers who enter into arrangements to ensure that COVID-19 patients receive free home oxygen equipment. Some hospitals have decided to take on the inherent risks in such an arrangement to address a
OIG Issues Special Fraud Alert on Speaker Programs
Earlier this week, the Office of Inspector General OIG issued a Special Fraud Alert (Alert) on speaker programs by pharmaceutical and medical device companies in connection with the Federal Anti-Kickback Statute. In the Alert, the “speaker programs” are defined as company-sponsored events at which a health care professional makes a speech or presentation to other
Have You Updated Your Corporate Compliance Program Lately?
New guidance issued by the U.S. Department of Justice (DOJ) highlights the importance of updating corporate compliance programs to satisfy regulatory requirements. The 2020 updates pick up where the 2019 guidance left off in addressing the evaluation metrics for compliance. The key takeaway for 2020 is that companies are encouraged to update and improve compliance
THE ABC’S OF THE S.I.U.: What Providers Need to Know
Medical record requests by payors are commonplace for health care providers. Typically, these requests are received by a front desk employee who responds to the inquiry in short order. Yet, not all requests should be treated the same. When a request for documentation is propounded by the “Special Investigation Unit” (S.I.U.) of an insurance company,
Medicare Appeals and Audit Waivers Amid the COVID-19 Pandemic
In the event of a national disaster or emergency under the Stafford Act or the National Emergencies Act and a Public Health Emergency Declaration by government officials, the Department of Health and Human Services (HHS) Secretary can temporarily waive certain Medicaid and Medicare criterion, which are commonly referred to as 1135 Waivers. By way
New Anti-Kickback Law Targets Opioid Crisis
On October 24, 2018, Congress enacted a new anti-kickback law that applies to many commercial health insurance plans, as well as Medicare and Medicaid. The law, known as the “Eliminating Kickbacks in Recovery Act of 2018” (the “Law”), was passed as part of the SUPPORT for Patients and Communities Act, which generally targets the national
(Ride)Sharing is Caring
The transportation landscape in America has evolved and these developments are now impacting health care. With about 75 percent of the U.S. population living in a county with access to an on-demand ride-hailing service, many patients are turning to ride-share services, like Uber and Lyft, as a means to obtain their medical care.
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CMS Provides Advice on Electronic Laboratory Alerts
CMS recently issued an Advisory Opinion suggesting that physicians who refer diagnostic tests reimbursable under Medicare to a laboratory may, under certain circumstances, receive electronic pop-up notifications in the laboratory’s web-based portal alerting the physicians to various potential issues related to the test results. In the Advisory Opinion, CMS considered certain alerts which a laboratory
Proposed New Jersey Regulation would Restrict Pharma Gifts to Prescribers
Gov. Christie’s Administration recently proposed a regulation to curtail the prescription of unnecessary opioid painkillers. Christie, who serves as the Chairman of President Trump’s Commission on Combating Drug Addiction and the Opioid Crisis, expressed concern that treatment decisions of all prescribers (including physicians, dentists and advanced practice nurses) are being improperly influenced by pharmaceutical companies.
New York man sentenced to 10 years in prison for involvement in $26 million “billing mill”
Earlier this month, a New York man was sentenced to 10 years in prison for allegedly operating a $26 million scheme to defraud Medicare and Medicaid. The defendant allegedly established 6 medical clinics in Brooklyn that paid elderly people to pose as patients and billed Medicare and Medicaid for unnecessary and/or non-existent medical care and