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
The 2010 Patient Protection and Affordable Care Act (“PPACA”) imposed an obligation upon Medicare providers, including physicians, hospitals, nursing homes and home health agencies, to report and return any overpayments they receive within 60 days of identification of the overpayment. Failure to do so could result in substantial penalties to the provider under the False
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
The U.S. Department of Health and Human Services (“HHS”) released a final rule concerning Health Insurance Exchanges (“HIE”) on March 12, 2012. The final rule will be published in the Federal Register on March 27, 2012. In late March, 2012, the U.S. Supreme Court will hear arguments concerning the constitutionality of the Patient Protection and
A recent decision in the Supreme Court, Kings County, has confirmed that health care providers have a private cause of action under N.Y. Insurance Law § 3224-a (the “Prompt Pay Law”).
In Maimonides Med. Ctr. v. First United Am. Life Ins. Co., 2012 NY Slip Op. 22039 (decided February 22, 2012), the Court determined
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.
The
Health care providers in New York that participate in Medicaid may be included in the latest cycle of the Centers for Medicare and Medicaid Services Payment Error Rate Measurement Program (“PERM”). PERM was developed in response to the Improper Payment Information Act, which requires that Federal agencies review programs that are prone to erroneous payments