The U.S. Department of Health and Human Services Office of Inspector General (“HHS-OIG”) has revealed a new section to its website dedicated to the state Medicaid Fraud Control Units (“MCFUs”). MCFUs are intended “to investigate and prosecute fraud by Medicaid providers as well as patient abuse and neglect.” While MCFUs are administered by the states, […]
The New York state attorney general’s office announced yesterday that it recovered more than $283 million and obtained a record of 148 Medicaid fraud convictions in 2009. This information is detailed in an Annual Report submitted to the Secretary of the U.S. Department of Health and Human Services. The report highlights the cases, settlements, and […]
Pursuant to the healthcare reform bill that was signed into law by President Obama on March 23, 2010 (“the Patient Protection and Affordable Care Act” or “the Act”), physicians who furnish MRI, CT or PET tests within their practices for their patients are now required to provide their patients with a written disclosure at the […]
The Office of Inspector General (OIG) has continued to indict, prosecute, and convict members of the healthcare community for allegedly violating the Civil Monetary Penalty (CMP) statue and the False Claims statute. Some notable prosecutions are below: – On February 2, 2010, Maria Aloise, the president and owner of Atenas Medical Equipment, Inc. (Atenas), was […]
Yesterday House Speaker Nancy Pelosi selected Congressman Pete Stark of California to head the powerful Ways and Means Committee, replacing New York Congressman Charlie Rangel, who has stepped aside temporarily amid ethics investigations. Stark is best known in health care for first proposing what is now known as “the Stark law,” which regulates physician self-referral, […]
One of HLP’s founding partners, Adrienne Dresevic, Esq., who specializes in Stark and fraud & abuse analysis, published a new article in the latest issue of the RBMA Bulletin, a publication of the Radiology Business Management Association. Adrienne’s article, entitled “Key Regulations Impacting Marketing: Entertainment and Gifts,” explains the regulatory limitations placed on health care […]
Shortly before the holidays, Boston Scientific agreed to pay $22 million to resolve allegations that its subsidiary, Guidant, paid kickbacks to physicians to induce them to use Guidant pacemakers and defibrillators, in addition to a previous agreement to pay a $296 million fine resulting from a criminal investigation relating to defective defibrillators. On December 23, […]
Alleging False Claims Act, Stark Law, and Anti-Kickback violations, the University of Medicine and Dentistry of New Jersey (UMDNJ) settled with the Department of Justice (DOJ) and the Department of Health and Human Services (HHS) for $8.3 million–double what Medicare paid for the allegedly improper referrals. UMDNJ is licensed as a Level I Trauma Center. […]
Centers for Medicare and Medicaid Services (CMS) noted that consignment closets (also known as stock and bill arrangements) have not complied with durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) supplier standards. As a result, CMS issued a Change Request (CR) affecting physicians and DMEPOS suppliers, which allows for consignment closets only when all of […]
OIG issued Advisory Opinion 09-10 permitting “network hospitals to discount the Medicare inpatient deductible for the Requestors’ policyholders….” Requestors are offer Medigap policies in a majority of US states. The Arrangement would allow for the Medigap policyholders to receive a 100% discount on Medicare Part A, inpatient deductibles received at participating hospitals and preferred provider […]
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