Physician ancillary service joint ventures continue to proliferate and not surprisingly, federal and state regulators are on the lookout for arrangements which may violate fraud and abuse laws . In
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Fraud and Abuse
DOJ Joins Whistleblower Case On 60-day Overpayment Refund Requirement
By Todd Rodriguez on
One of the often overlooked requirements in the federal Affordable Care Act is that healthcare providers now have an obligation to refund overpayments to the Medicare within 60 days of…
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OIG Proposed Rule on New Civil Money Penalty Authorities
By Todd Rodriguez on
The Office of Inspector General (OIG) today issued a proposed rule which would amend the federal civil monetary penalty (CMP) regulations addressing new CMP authorities created under the Affordable Care…
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Does Your Group Practice Income Division Formula Comply with Stark
By Todd Rodriguez on
Many physicians I speak with are still surprised to learn that the federal Stark statute imposes restrictions on income division within group practices. These restrictions only apply to profits generated…
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The Compliance Program Mandate is Coming – Don’t Wait for It
By Todd Rodriguez on
It is still evident to me that too many physician practices still do not have effective fraud and abuse compliance programs integrated into their practices. To date there has been…
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What Do Your Coding Statistics Say About You?
By Todd Rodriguez on
One of the ways the Medicare program and other payer plans are recovering overpayments and identifying billing fraud is through the regular use of data mining. Simply put, by utilizing…
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Tuomey Case Puts Sharp Emphasis on Fair Market Value in Physician Transactions
By Todd Rodriguez on
Earlier this month the closely watched case of U.S. ex rel Drakeford v Tuomey Healthcare System Inc. (675 F.3d 394 (4th Cir. 2012) concluded with a jury finding that the…
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Office of Inspector General Guidance on Physician-owned Distributorships “PODs”
By Todd Rodriguez on
On March 26, 2013, the Office of Inspector General published much-awaited guidance on physician-owned medical device distributorships (commonly known as “PODs”) in the form of a Special Fraud Alert. …
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President Proposes Eliminating Stark In-Office Ancillary Services Exception For Therapy and Advanced Imaging
By Todd Rodriguez on
In what would undoubtedly be a devastating blow to many medical practices that rely on the Stark in-office ancillary services exception (which allows physicians to refer within their practices for…
DOJ Announces Record Fraud Settlement Against Physician
By Todd Rodriguez on
Yesterday the U.S. Department of Justice announced that it has entered into a $26M False Claims settlement with a dermatologist in Florida. According to the DOJ, this is one of the…
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