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
Two practices in Connecticut recently settled large six-figure lawsuits with federal and state agencies resolving allegations of improperly employing an individual who was excluded from all federal healthcare programs. In both instances, the... Read More
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
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
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
Last week, the United States Department of Justice ("DOJ") announced that an orthopedic surgeon had been indicted by a federal grand jury due to his alleged involvement in a $10 million fraudulent healthcare scheme. According to the DOJ, the surgeon... Read More
The government increasingly has its sights set on various healthcare frauds that result in major financial losses to its healthcare programs such as Medicare, Medicaid, and TRICARE. Recently, the expanded enforcement efforts have included the foot... Read More
In its ongoing effort to combat healthcare fraud, the Department of Justice (“DOJ”) arrested and charged a New York orthopedic surgeon for allegedly submitting approximately $10 million in fraudulent claims to Medicare on April 21, 2022. These... Read More
On October 5, 2021, the U.S. Department of Health and Human Services, Office of the Inspector General (“OIG”), published an Advisory Opinion (AO# 21-14) regarding a proposal to extend an existing discount program for chiropractic patients to... Read More
The revocation of enrollment in the Medicare program is an ever-present threat for providers and/or suppliers (“health care providers”). Federal regulations allow the Centers for Medicare & Medicaid Services (“CMS”) to revoke the... Read More
