Liability under the Civil False Claims Act has been expanded. On May 20, 2009, President Obama signed the Fraud Enforcement and Recovery Act (FERA) into law. FERA contains amendments to the civil False Claims Act (FCA) that expand liability under FCA and gives the government increased powers to investigate. According…
The Office of the Inspector General (the “OIG”) posted new Advisory Opinion 09-03 on April 30, 2009, which concerns an arrangement whereby three municipalities reciprocally waive the otherwise applicable cost-sharing obligations of individuals residing within each other’s borders when providing backup emergency medical services transportation. Based on the facts presented,…
In an Open Letter to health care providers published March 24, 2009, the Office of Inspector General (“OIG”) refined its Self-Disclosure Protocol (“SDP”) to resolve matters giving rise to civil monetary penalties (“CMPs”) under the federal Stark law and Anti-Kickback Statute, initially addressed by way of Open Letter dated April…
Generally speaking, the Federal Stark law makes it unlawful for a physician to refer Medicare or Medicaid patients for designated health services (“DHS”) to an entity with which the physician (or an immediate family member) has a financial relationship, unless an exception applies. The Federal Stark law applies only to…
A recent Federal appeals court decision paved the way for a whistleblower to proceed with a False Claims Act (“FCA”) case involving allegations of Stark and Anti-kickback Statute violations regarding an exclusive anesthesia coverage agreement and pain management services arrangement. This case is important as it highlights how courts and…
According to the Office of Inspector General (“OIG”) 2009 Work Plan, “incident to” services continue to be an area of scrutiny. The OIG is currently reviewing this billing area and expects to issue a report of its findings in 2009. In summary, in order to bill “incident to” services, the…