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Please Click HerePosted on November 18, 2016 by Ruder Ware Alumni
The Department of Health and Human Services has issued new interim final rules to adjust a variety of Federal Civil Penalties for inflation. The Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015 required the agency to promulgate a “catch-up adjustment” in these penalties through an interim final rule. Additionally, HHS agencies were instructed […]
Posted on November 17, 2016 by Ruder Ware Alumni
In June, I published a blog article on a decision of the United States Supreme Court that appeared to change the law applicable to “false certification” in the 7th Judicial Circuit Circuit. The Supreme Court decision in Universal Health Services v. United States ex rel. Escobar, 136 S. Ct. 1989 (2016), (“Escobar”) opened the door to […]
Posted on November 7, 2016 by Ruder Ware Alumni
The Federal False Claims Act (“FCA”) provides a very strong enforcement tool to the federal government. The FCA also provides the opportunity for whistleblowers to bring “qui tam” cases and collect a portion of the recovery where false claims are proved against the federal government. FCA recovery was originally intended to provide a remedy against […]
Posted on November 7, 2016 by Ruder Ware Alumni
The decision whether or not to voluntarily disclose non-compliance to the government can be very difficult. Not every case is clear. Clearly not every situation where there has been a billing error amounts to fraud or wrongdoing requiring use of the self-disclosure protocol. Many overpayments that are identified through audit can be dealt with at […]
Posted on November 7, 2016 by Ruder Ware Alumni
If you are involved in any way in the health care system, it should be obvious by now that the government has committed ever increasing resources to the prosecution of fraud and abuse cases. Simply put, from a governmental standpoint, prosecuting fraud and abuse is good business. Every dollar the government puts into pursuing health […]
Posted on November 2, 2016 by Ruder Ware Alumni
On October 4, 2016, the Center for Medicare and Medicaid Services (CMS) published a final rule to revise the requirements that Long-Term Care facilities must meet to participate in the Medicare and Medicaid programs. CMS states that the revisions to nursing home regulations are intended to reflect the substantial advances that have been made in […]
Posted on November 2, 2016 by Ruder Ware Alumni
When Congress originally passed the False Claims Act (31 USC §§ 3729-3733), no one had the health care system in mind. The False Claims Act was also commonly referred to as the “Lincoln Law”. The original law was focused on unscrupulous vendors who provided overpriced and often faulty supplies to the military during the Civil […]
Posted on September 30, 2014 by Ruder Ware Alumni
A Federal Whistleblower that was recently settled in the United States District Court for the Middle District of Tennessee illustrates the difficult issues involved in structuring ambulatory surgery center (“ASC”) investments. Specifically, the case demonstrates how investment terms that are intended to assure compliance with the safe harbor regulations under the Medicare Anti?Kickback Statute (42 […]
Posted on June 26, 2014 by Ruder Ware Alumni
A recent federal court decision from Pennsylvania illustrates the importance of a confidentiality agreement as part of a compliance program. The Pennsylvania court found that a confidentiality agreement that had been signed by an employee restricted the ability of the whistleblower claimant to use confidential information to support its qui tam claim under the federal […]
Posted on June 19, 2014 by Ruder Ware Alumni
Very recently, we have seen commercial payors begin to roll out provider scoring systems. Information about the specifics of these systems is still developing, so I am not providing details at this time. Some of you may have already encountered this issue in connection with United Health’s provider tiering system. Under this scoring system, payors […]