The Office of Inspector General (“OIG”) of the Department of Health and Human Services, generally, would have concerns about a potential or existing referral source receiving free goods or services,
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Fraud and Abuse
OIG Issues Advisory Opinion on Transportation Aid and Lodging Benefits
By Edward J. Cyran on
In a recent Advisory Opinion (No. 16-02), the OIG concluded that it would not seek sanctions against a state-run hospital (the “Hospital”) under the federal anti-kickback statute or the civil…
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Nursing Home Fraud Scam Results in Conviction for “King of Nursing Homes”
By Edward J. Cyran on
Called by some the “King of Nursing Homes” for his many low-income nursing home patients in northeast Illinois, Dr. Venkateswara Kuchipudi was recently convicted for referring patients to Sacred Heart…
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CMS Finally Makes Reasonable Changes to 60-Day Overpayment Rule
By Edward J. Cyran on
The Affordable Care Act (ACA) requires Medicare providers to return overpayments within 60 days of the date they are identified in order to avoid liability under the False Claims Act. …
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First Court Decision on the Medicare/Medicaid 60-day Overpayment Rule
By Edward J. Cyran on
You may have heard some years ago that the Affordable Care Act established a “60-day overpayment rule” that requires a provider to report and return any overpayment from a federal…
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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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2012 is Record Year for Fraud Recovery
By Todd Rodriguez on
The Obama administration announced today that as a result of increased federal health care fraud and abuse enforcement efforts, the federal government recovered $4.2 billion in 2012, setting a new…