On June 29, 2022, the Department of Justice (“DOJ”) announced the formation of the New England Prescription Opioid (NEPO) Strike Force. This strike force will investigate and vigorously prosecute healthcare providers involved in healthcare fraud... Read More
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According to the DOJ’s indictment, Ms. Lavache prescribed DME for Medicare beneficiaries without conducting any consultations with the said beneficiaries. As a result, she allegedly caused the submission of false claims to Medicare totaling... Read More
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This firm, in a series of articles, has made clear the importance of maintaining accurate information regarding physician profiles in the National Practitioner Data Bank ("the NPDB"), a database operated by the U.S. Department of Health and Human... Read More
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Earlier this week, the U.S. Supreme Court ruled that to secure convictions under the federal Controlled Substances Act (“CSA”) for excessive prescribing of controlled substances, including opioids, prosecutors must prove beyond a reasonable... Read More
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Last week, the United States Department of Justice (“DOJ”) announced that a Georgia marketer pled guilty for his role in a conspiracy to violate the Federal Anti-Kickback Statute and commit health care fraud. The marketer was charged with taking... Read More
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Earlier this month, two telehealth bills intended to expand patient access to virtual healthcare were introduced to the United States Congress.  Each bill seeks to continue building upon the availability of certain telehealth services that existed... Read More
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On May 9, 2022, the Centers for Medicare and Medicaid Services (CMS) released a Final Rule (Final Rule) entitled, “Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs.” ... Read More
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Providers should be aware of CMS’s recent aggressively restrictive stance on Medicare Advantage (“MA”) risk adjustment coding. In  U.S. ex rel. Teresa Ross v. Independent Health Association, et al. – a False Claims Act (“FCA”) case... Read More
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The closely-watched Kaiser Permanente consolidated False Claims Act (“FCA”) action, involving allegations of substantial Medicare Advantage risk adjustment fraud, has highlighted the dangers of a particular coding practice/policy known as... Read More
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