The Department of Justice’s (“DOJ“) Criminal Division announced, through its Assistant Attorney General, Leslie R. Caldwell, that the DOJ is closely scrutinizing civil False Claims Act investigations and lawsuits for criminal conduct. Speaking at the Taxpayers Against Fraud Education Fund’s annual conference in Washington D.C., Ms. Caldwell asked attorneys contemplating filing qui tam lawsuits to […]
As expected, the U.S. Department of Health and Human Services (“HHS“) officially set the ICD-10 compliance date for October 1, 2015. Previously, providers and payors had until October 1, 2014 to transition from the ICD-9 to the ICD-10 Procedure Coding System. However, the Protecting Access to Medicare Act of 2014 prevents HHS from adopting ICD-10 […]
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, HCPs have been classified as […]
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 health care providers were unable […]
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 (non-Medicare) will implement new quantity […]
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 subcontracts. The Federal Acquisition Regulation […]
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 would then be followed by […]
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 Co., No. 05-cv-1276 (D.D.C. Mar. […]
The landscape of the Medicare appeals process is quickly changing with the launch of the Settlement Conference Facilitation (“SCF”) pilot program. The program is designed to be an alternate dispute resolution process where the appellant and the Centers for Medicare & Medicaid Services (“CMS”) come together to discuss a potential mutually agreeable resolution of claims […]
On July 8, 2014, the Office of Medicare Hearings and Appeals (“OMHA”) posted to its website a new sampling pilot initiative to address large volumes of claims pending at the ALJ stage of appeal. The sampling request can be initiated by an appellant, or OMHA may offer an appellant the sampling pilot. To be eligible […]
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