Last week, the Second Circuit held that a False Claims Act relator does not have to plead details of specific alleged false billings or invoices to the government, as long as he can allege facts leading to a strong inference that specific claims were submitted and that information about them are peculiarly within the defendant’s
Percentage-Based Billing Contracts Violate Medicaid Regulations and May Constitute Improper Fee-Splitting
The Medicaid Fraud Control Unit (MCFU) of the New York State Office of the Attorney General has recently issued restitution demand letters to providers for allegedly entering into percentage-based contracts with their billing agents. The MCFU letters cite the Medicaid Update March 2001, titled “A Message for Providers Using Service Agents” as follows:
Who is a “Qualified Person” for Purposes of Access to a Patient’s Medical Records
In our previous post [found here], we explained that, under the Privacy Rule, HIPAA covered entities (health care providers and health plans) must provide individuals and their “personal representatives” with access to the individual’s protected health information. An individual’s personal representative is determined under State law. In this post, we will define
The Individual’s Rights Under HIPAA to Access their Health Information- Verifying the Identity of the Person Requesting PHI
Under the Privacy Rule, HIPAA covered entities (health care providers and health plans) are required to provide individuals, upon request, with access to their protected health information (PHI) in one or more “designated record sets” maintained by or for the covered entity.
Covered entities are also required to protect the individual’s PHI from unauthorized disclosure.
5 Lessons for Health Care Providers from Joan Rivers’ Death
On November 10, 2014, the US Department of Health and Human Services released its investigation report regarding the death of actress and comedian Joan Rivers. The report, called a “Statement of Deficiencies and Plan of Correction”, highlights numerous mistakes and violations made by Yorkville Endoscopy, the treating facility where Ms. Rivers died (Ms. Rivers
Dismissal Motions Filed In SDNY Computer Glitch Reverse False Claim Act Case
When does the 60-day clock start for an identified overpayment of federal funds to become a reverse false claim under amendments to the False Claims Act? A closely watched SDNY qui tam case may provide an answer.
In June, the United States and New York intervened in United States v. Continuum Health Partners, Inc.,
Shareholder Liability for the Misconduct of Others: What is “Direct Supervision and Control?”
Physicians often practice through a limited liability entity to shield the physician from practice liabilities. In New York, such entities may take the form of a professional service corporation, professional limited liability company, or professional limited liability partnership. Regardless of the type of entity selected, professionals in New York remain “personally and fully liable and
October Jury Trial in EDNY False Claims Act Case
False Claims Act cases do not often go to trial, so they are noteworthy when they do. EDNY Judge John Gleeson has scheduled an FCA jury trial in October, United States ex rel. Ryan v. Lederman. Earlier this year, the Court granted summary judgment to the government in part and scheduled the remaining issues
A Refresher on Noncompetes for Health Professionals
A recent article in the New York Times examined the growth of noncompete agreements, noting “Noncompete clauses are now appearing in far-ranging fields beyond the worlds of technology, sales and corporations with tightly held secrets, where the curbs have traditionally been used. From event planners to chefs to investment fund managers to yoga instructors, employees
Court of Appeals Upholds Comptroller Audit Of Non-Participating Provider’s Billing Records
The New York Court of Appeals decided last week, in Handler v. DiNapoli, that the State Comptroller has the authority to review the billing records of a non-participating provider receiving funds from the State’s primary health benefit plan, even though the payment of state funds is made indirectly.
New York State provides health