In an attempt to combat prescription drug abuse, on August 22, 2014, the U.S. Drug Enforcement Administration (“DEA”) published a final rule (here) elevating Hydrocodone-combination products (“HCPs”) to the more restrictive schedule II category of drugs under the Controlled Substances Act (“CSA”). Since the enactment of the CSA in 1971,…
On September 4, 2014, the Department of Health & Human Services, Centers for Medicare & Medicaid Services (“CMS”), published a final rule (See, 79 FR 52910) modifying the Medicare and Medicaid Electronic Health Record Meaningful Use Incentive Program (“EHR Meaningful Use Incentive Program”). The reason for the modification is that…
With the fight against prescription drug abuse reaching an all-time high, health insurance plans are now taking a proactive role in attempting to reduce the quantity of some of the most abused drugs in the marketplace. As of September 2, 2014, Blue Cross Blue Shield of Michigan (BCBSM) commercial plans…
On August 12, 2014, the Office of Inspector General (“OIG“) posted new guidance for contractors self-disclosing violations of federal criminal law involving fraud, conflict of interest, bribery, or gratuity violations or violations of the civil False Claims Act in connection with U.S. Department of Health and Human Services contracts or…
One of the most widely viewed False Claims Act (FCA) cases filed against a hospital is coming to an end–Florida hospital, Halifax Health, is preparing to pay $1 million to settle a $73 million dollar Medicare overbilling case. Potentially, maximum damages in the trial could have exceeded $200 million, which…
Companies doing business in highly-regulated industries, including the health care industry, were left holding their breath after a D.C. district court ruled that the attorney-client privilege doctrine did not attach to a company’s internal investigation conducted under the direction of in-house legal counsel. United States ex rel. Barko v. Halliburton…
On May 9 and May 12, 2014, the United States Department of Health and Human Services (“HHS”) published two proposed rules that would significantly expand the authority of the Office of Inspector General (“OIG”) to exclude providers from participation in federal health care payor programs and impose civil monetary penalties.…
On May 19, 2014, Centers for Medicare and Medicaid Services (“CMS”) announced that it is considering new ways to define and pay for hospital short-stays. In October 2013, CMS implemented the “Two-Midnight Rule” with the goal of bringing clarity to billing for Part A inpatient hospital admissions. However, the Rule…
The Program for Evaluating Payment Patterns Electronic Report (“PEPPER”) is an electronic data report under contract with the Centers for Medicare & Medicaid Services (“CMS”) that helps guide hospital’s auditing and monitoring services. In 2014, PEPPER published new target areas for Short-Term Acute Care hospitals that were identified as prone…
On Tuesday, May 13, 2014, the Department of Justice (“DOJ”) and Department of Health and Human Services (“DHHS”) held a joint news conference to announce that the Medicare Fraud Strike Force had conducted a nationwide takedown of 90 individuals involving approximately $260 million in fraudulent Medicare billings. The nationwide takedown…