In U.S. ex rel. Wolfson v. Park Avenue Medical Associates, the U.S. Attorney’s Office in the Southern District of New York entered into a $1 million False Claims Act settlement against three related companies for improperly billing Medicare for behavioral health services. The settlement agreement provided that the defendants “admit, acknowledge and accept responsibility
A bill proposed in the US House of Representatives may cause physicians to significantly restructure their practices as they relate to in-office ancillary services (IOAS).
Promoting Integrity in Medicare Act of 2013
The Stark Law is a federal statute which prohibits physicians from making referrals for Medicare-covered designated health services (DHS) to an entity with
Earlier this month, a bill to amend the False Claims Act (“FCA”), the “Fairness in Health Care Claims, Guidance and Investigations Act,” was introduced in the House of Representatives. According to one of the bill’s sponsors, Rep. Howard Coble (R-NC), the bill’s purpose is to ensure that unintentional billing disputes are not penalized as
Earlier this week, the Department of Justice announced that it had recovered nearly $5 billion in settlements and judgments under the False Claims Act in fiscal year 2012. The $4.959 billion figure was a new record for a single year, eclipsing the previous one-year record by $1.7 billion.
In breaking down the $5 billion in
The New York State Office of the Medicaid Inspector General (“OMIG”) recently finalized regulatory changes to New York State law which relate to the withholding of payments to Medicaid providers when there is a “credible allegation of fraud.” A credible allegation of fraud is defined as an “allegation that has indicia of reliability and has
Several health care industry companies, including Medicis, ArthroCare and Amedisys, reported in their 2012 first quarter reports that they were under Department of Justice investigations and had received civil investigative demands from the government.
Civil investigative demands, referred to as CIDs, are a particularly powerful pre-lawsuit administrative tool for federal investigations. Using CIDs, the government
The recent decision in United States ex. rel. Drakeford v. Tuomey Healthcare Sys. Inc., No. 10-1819 (4th Cir. Mar. 30, 2012) provides a sobering reminder that hospital-physician contracts should be drafted carefully in order to avoid containing any provisions that could inadvertently result in Stark law liability.
Subject to certain limited exceptions, the federal
The U.S. Attorney’s Office for the Southern District of New York recently announced the settlement of a health care False Claims Act case against Beth Israel Medical Center for fraudulently inflating its fees for services provided to Medicare patients in order to obtain larger “outlier payments.” Beth Israel agreed to pay over $13 million to
In a recent Southern District of New York decision, Judge Jed S. Rakoff examined the original source exception to the False Claims Act’s (“FCA”) public disclosure bar. In United States ex rel. Associates Against Outlier Fraud v. Huron Consulting Group, Inc., 2012 WL 506824 (S.D.N.Y. Feb. 16, 2012), the relator alleged that defendant Huron
Employment arrangements between hospitals and physicians often include productivity-based compensation. This can be in the form of bonuses or adjustments to salary. A common measure of productivity is the physician’s work Relative Value Units (“RVUs”). Such productivity measures are intended to motivate newly-hired physicians and to support the fairness of compensation paid and earned.
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