On July 28th, 2016, the Department of Justice released a report stating that the Lexington County Health Services District will pay $17 million for violations of the Physician Self-Referral Law (the Stark Law) and the False Claims Act. The Department alleged that Lexington Medical Center (“LMC”) violated the Stark Law (which prohibits physicians from referring […]
Attorney General Eric T. Schneiderman and United States Attorney Preet Bharara announced a $2.95 million fraud settlement with three hospitals in the Mount Sinai Health System resulting from Medicaid overpayments. A whistleblower alleged that Mount Sinai Beth Israel, Mount Sinai St. Luke’s, and Mount Sinai Roosevelt knowingly retained over $844,000 in Medicaid overpayments beyond the […]
On July 25th, The Centers for Medicare and Medicaid Services (CMS) released a new proposed rule which could materially change the Medicare payment model for hospitals in 98 randomly selected metropolitan statistical areas. The proposed rule contemplates the creation of new bundled payment models for cardiac care, in addition to the extension of the existing […]
All healthcare organizations should maintain an emphasis on compliance not on an episodic basis (e.g., in response to an enforcement-related development). Rather, an institutional commitment to compliance should be an integral part of an organization’s culture, with appropriate resources and leadership support. In connection, it is instructive to revisit the principles of the DOJ’s ‘Yates […]
On June 27th, 2016, a proposed rule was published in the Federal Register that could adversely affect home healthcare agencies. The Centers for Medicare & Medicaid Services (CMS) proposed significant reductions in Medicare reimbursements for home healthcare agencies. Such reductions would take effect in 2017, totaling $180 million, or about a 1% cut in funding. […]
On July 28th, 2016, researchers from Harvard, in conjunction with researchers from several hospitals, published a study in the BMJ which found that the implementation of new electronic health records (EHRs) systems does not have material repercussions on patient care in hospitals. The study observed 17 hospitals implementing new EHRs, along with a control group […]
On July 29, 2016, the Centers for Medicare & Medicaid Services (“CMS”) announced that it is expanding statewide (and extending for an additional six (6) months), the temporary enrollment moratoria on new Medicare Part B home health agencies (“HHAs”) in Florida, Texas, Illinois, and Michigan. The statewide expansion also applies to Medicaid and Children’s Health […]
The United States Department of Health and Human Services has new actions planned to address the opioid crisis. The buprenorphine rule has been finalized, which allows physicians who have waivers to prescribe buprenorphine products (e.g., Suboxone) for up to 100 patients for 1 year or more to obtain a waiver to treat up to 275 […]
New rules published on June 30th, 2016 in the Federal Register could dramatically change the regulatory enforcement landscape for healthcare providers, with fraud penalties nearly doubling under the False Claims Act and the Anti-Kickback Act. The False Claims Act (which in pertinent part imposes penalties on healthcare providers for submitting false claims to a government […]
On Thursday, the U.S. Supreme Court issued a decision that recognizes implied certification as a viable theory under which to pursue False Claims Act cases against healthcare providers. Implied certification can impose liability if a contractor has engaged in a lie by omission, for instance, failing to disclose its noncompliance. In the case, Universal Health […]
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