During the 2021 fiscal year, The U.S. Department of Justice (DOJ) recovered $5.6 billion in civil settlements and judgments involving fraud and violations of the False Claims Act; a record-breaking $5 billion of this recovery was derived from... Read More
The Federal Anti-Kickback Statute (the “AKS”) prohibits the payment or receipt of remuneration to induce or reward referrals of items or services reimbursable by a federal health care program (including, but not limited to, Medicare and... Read More
The Office for Civil Rights (OCR) announced a settlement with Oklahoma State University – Center for Health Services (OSU-CHS) related to a hacking incident that compromised the protected health information (PHI) of 279,865 individuals. The... Read More
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
On June 15, 2022, the Supreme Court of the United States ruled unanimously in favor of several hospital groups concluding that the Department of Health and Human Services (HHS) exceeded its statutory authority by implementing a discriminatory... Read More
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
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
Reporting to the National Practitioner Data Bank (“NPDB”) is required when certain adverse clinical privilege actions involving professional competence or conduct of physicians occur. Reports submitted in response to negative actions or findings... Read More
The U.S. Department of Health and Human Services (“HHS”) recently announced a clawback of funds disbursed by Health Resources and Services Administration (“HRSA”) under the Coronavirus Aid, Relief and Economic Security (“CARES”) Act.... Read More
On April 20, 2022, the Department of Justice (DOJ) announced criminal charges against twenty-one (21) defendants in nine federal courts across the country for their roles in Coronavirus-related healthcare fraud schemes that resulted in more than... Read More
