Two landmark cases fraught with False Claim Act (“FCA”) allegations of fraudulent billing for prescription drugs against food and pharmacy chains are making their way from the Seventh Circuit to
Continue Reading Is it Really Fraud? The Supreme Court Will DecideThe Federal Government’s Continued Focus on COVID-19 Aid Fraud Leads to New Charges, Convictions and Sentencings
The Department of Justice’s continued focus on prosecuting fraud related to pandemic relief programs has resulted in a new batch of criminal charges, convictions and penalties for those who have
Continue Reading The Federal Government’s Continued Focus on COVID-19 Aid Fraud Leads to New Charges, Convictions and Sentencings
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,
Continue Reading THE ABC’S OF THE S.I.U.: What Providers Need to Know
Offering Discounts (or Waivers) of Coinsurance/Copayments to Patients as an Out-of-Network Provider
Commercial payors are actively looking for ways to reduce payments to out-of-network providers. One area of focus is discounts and waivers of patient copayments and deductibles by out-of-network providers. In
Continue Reading Offering Discounts (or Waivers) of Coinsurance/Copayments to Patients as an Out-of-Network Provider
OIG Publishes Fraud Alert on Physician Lab Arrangements
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
Continue Reading OIG Publishes Fraud Alert on Physician Lab Arrangements
Does Your Group Practice Income Division Formula Comply with Stark
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
Continue Reading Does Your Group Practice Income Division Formula Comply with Stark
DOJ Announces Record Fraud Settlement Against Physician
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
Continue Reading DOJ Announces Record Fraud Settlement Against Physician
Enforcement Update – Bad Actors Continue to Pay
Recent press releases provide notice of activities that draw the government’s ire — and result in serious criminal consequences. Focusing on these issues is a helpful exercise for any physician trying to stay within the law.
Continue Reading Enforcement Update – Bad Actors Continue to Pay
Fraud and Abuse Compliance More Important Than Ever
Health care fraud and abuse enforcement activity is at an all-time high yet many physicians and other providers lack a basic understanding of the key healthcare fraud and abuse statutes
Continue Reading Fraud and Abuse Compliance More Important Than Ever
Feds Announce Largest Single Physician Medicare Fraud Bust
I have been speaking with physicians for years about the importance of developing effective fraud and abuse compliance programs in their practices and I often still get the same response: The government is
Continue Reading Feds Announce Largest Single Physician Medicare Fraud Bust