Life Spine Settles FCA Kickback Case for $6 Million
October 31, 2019 | Eric D. Fader | Affordable Care Act | False Claims Act | Fraud and Abuse | Litigation | Medical Devices and Wearables | Medicare and Medicaid
Spinal implant manufacturer Life Spine Inc. and two of its executives have settled their False Claims Act case by agreeing last week to pay the federal government $6 million. As discussed here, the company and executives had been accused of paying kickbacks to surgeons to use the company’s products. In addition to paying $5.5 million …
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Hospital to Pay $20 Million to Settle Whistleblower Case
October 29, 2019 | Eric D. Fader | False Claims Act | Fraud and Abuse | Hospitals | Litigation | Medical Devices and Wearables | Medicare and Medicaid
The U.S. Department of Justice (DOJ) announced on October 28 that Sanford Health, a hospital in Sioux Falls, South Dakota, will pay $20.25 million to settle a whistleblower lawsuit alleging violations of the False Claims Act and federal Anti-Kickback Statute. Two surgeons at the hospital filed the suit alleging that the hospital allowed another surgeon …
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Florida Hospital Fined $2.15 Million for Theft and Sale of Records
October 24, 2019 | Ada Kozicz | Electronic Health Records | HIPAA | Hospitals | Litigation
The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) announced on October 23 that Jackson Health System (JHS) in Miami has received a civil money penalty of $2,154,000 for violations of HIPAA’s Security and Breach Notification Rules. OCR Director Roger Severino said, “OCR’s investigation revealed a HIPAA compliance program that had …
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Shapiro to Present on Nutrition Labeling Regulations for the AHPA
October 23, 2019 | Rivkin Rounds Staff | FDA | Legislation and Public Policy
Steven Shapiro will be a speaker on a webinar offered by the American Herbal Products Association (AHPA) entitled “Compliance with FDA’s Revised Nutrition Labeling Regulations for Herbal Supplements.” Scheduled for October 29 from 1-3 pm, the program will offer an overview of new federal nutrition labeling requirements, which take effect Jan. 1, 2020, for manufacturers …
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CMS Announces New Medicare Program Integrity Strategy
October 23, 2019 | Eric D. Fader | Fraud and Abuse | Home Health | Legislation and Public Policy | Medicare and Medicaid
In an October 21 blog post titled “The Future of Medicare Program Integrity,” Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma described a new five-pronged approach to combat waste, fraud, and abuse in the Medicare program. The five “pillars” of the initiative are: Stop bad actors. CMS works with the Office of Inspector …
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NY DFS Proposes “Surprise Bill” Amendment
October 15, 2019 | Eric D. Fader | Hospitals | Legislation and Public Policy | Private Insurers
On October 10, the New York State Department of Financial Services released a proposed amendment to the state’s Out-of-Network Law. If approved, the amendment would require insurance companies and healthcare providers to comply with several new requirements to better protect consumers from “surprise” medical bills. Insurers that receive a claim for services rendered by a …
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Proposed Changes to Stark Law Promote Value-Based Provider Arrangements
October 11, 2019 | Benjamin P. Malerba | Ada Kozicz | Fraud and Abuse | Legislation and Public Policy | Medicare and Medicaid
As part of the U.S. Department of Health and Human Services’ “Regulatory Sprint to Coordinated Care,” the U.S. Office of Inspector General (OIG) and the Centers for Medicare and Medicaid Services (CMS) coordinated their efforts in issuing proposed changes to the federal fraud and abuse laws which prohibit certain patient referrals. The changes are intended …
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Genetic Testing Fraud Trend Attracts DOJ Attention
October 8, 2019 | Eric D. Fader | Fraud and Abuse | Litigation | Medicare and Medicaid | Telehealth
The U.S. Department of Justice (DOJ) recently announced fraud charges against 35 individuals in five federal districts for defrauding Medicare of more than $2.1 billion in medically unnecessary genetic testing. The announcement of the coordinated actions, which involved dozens of telemedicine companies and genetic testing laboratories, eight physicians and two nurse practitioners, was foreshadowed by a Fraud …
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Yelp Responses Lead to HIPAA Settlement
October 4, 2019 | Ada Kozicz | HIPAA | Litigation
A recent settlement between a Texas dental practice and the U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) demonstrates that healthcare providers must think twice before sharing any information on social media that can be linked to a patient. OCR investigated Elite Dental Associates of Dallas after receiving a patient complaint …
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Wave of DOJ Actions Targets Healthcare Fraudsters
October 3, 2019 | Eric D. Fader | False Claims Act | Fraud and Abuse | Home Health | Litigation | Medical Devices and Wearables | Medicare and Medicaid | Pharmaceuticals | Telehealth
The U.S. Department of Justice (DOJ) kicked its healthcare fraud enforcement activities into high gear last week, unveiling charges against hundreds of individuals and companies for paying kickbacks and billing for unnecessary drugs, supplies and tests. The cases, which alleged nearly $1.5 billion in fraudulent claims to Medicare, Medicaid and private insurers, targeted specialty pharmacies, …
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