Until October 2009, physicians could lawfully act as service providers to hospitals by furnishing their services “under arrangements” where a physician or group of physicians would provide services, equipment and supplies to a hospital’s patients by contracting with the hospital to provide the services. Urologists, for instance, regularly furnished lithotripsy…
The Office of Inspector General (“OIG”) has posted its Health Care Fraud Prevention and Enforcement Action Team (“HEAT”) compliance training resources on its website wherein it provides videos and audio podcasts regarding a number of topics, including: An overview of the OIG Overviews of the healthcare fraud and abuse laws;…
On December 7, 2011, the Office of Inspector General (“OIG”) posted a favorable Advisory Opinion 11-18 pertaining to Requestor’s online service that would facilitate the exchange of information between healthcare practitioners, providers and suppliers (“Proposed Arrangement”). Requestor, a publicly traded company, currently provides web-based services that help physicians “achieve faster…
According to a press release, the Department of Health and Human Services (“HHS”) announced that it will be awarding $9 million from the Centers for Medicare and Medicaid Services (“CMS”) to Senior Medicare Patrol (“SMP”) programs across the country tasked at fighting Medicare fraud. SMP is operated by the Administration…
CMS Issues 2012 Final Physician Fee Schedule. On July 19, 2011, the Centers for Medicare and Medicaid Services (“CMS”) published in the Federal Register its CY 2012 Physician Fee Schedule Proposed Rule (“Proposed Rule”). On November 1, 2011, CMS issued its 2012 Final Physician Fee Schedule (“Final Rule”), in part,…
Premier Home Care, a Durable Medical Equipment company operating in Indiana and Kentucky, agreed to pay a $578,820 settlement with the United States Department of Justice and the State of Indiana in a Whistleblower action alleging violations of the False Claims Act. In 2008, a former employee filed suit against…
In the Office of Inspector General (“OIG”) Advisory Opinion 11-15, dated October 11, 2011, the OIG analyzes an arrangement in which Requestor is a Delaware Limited Liability Company owned and managed by a physician (the “Owner/Manager”) which would enter into a management contract with an existing or to be formed…
In the Office of Inspector General (“OIG”) Advisory Opinion 11-14, dated October 7, 2011, the OIG analyzes an arrangement in which Requestor is an opthalmic physician group practice that provides cataract surgeries and also employs optometrists. By way of brief background, generally, patients receiving cataract surgery may elect to have…
In July, the HEALTH LAW ATTORNEY BLOG reported on five U.S. Senators asking the Office of Inspector General (“OIG”) and the Centers for Medicare and Medicaid Services (“CMS”) to issue guidance on physician owned distributorships (“PODs”) (or, sometimes referred to as physician owned intermediaries (“POIs”)). The OIG and CMS have…
On September 1, 2011, the Department of Justice, the Department of Health and Human Services (HHS), the FBI and the HHS Office of Inspector General (HHS-OIG) jointly announced that eighteen individuals have been charged in the Eastern District of Michigan for their participation in a series of separate Medicare fraud…