The U.S. Department of Justice (DOJ) announced on November 15 that Sutter Health, a northern California health system, agreed to pay a total of $45.6 million to settle allegations that it violated the Stark Law in submitting claims to Medicare for services. Sacramento Cardiovascular Surgeons Medical Group Inc. (Sac Cardio), whose physicians referred patients to Sutter, also

On November 15, the U.S. Department of Health and Human Services (HHS) announced the release of two healthcare price transparency rules. One is a final rule requiring hospitals to make available online all standard charges for items and services, including discounted rates negotiated with third-party payers. The second is a proposed rule that would require

The Center for Medicare & Medicaid Innovation, part of the Centers for Medicare & Medicaid Services, recently released its Request for Applications for the new “Primary Care First” payment model. The program will now begin in 2021 rather than the 2020 start date that was originally proposed in April, as discussed here. CMS said it

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

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

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

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

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

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,

As Medicare open enrollment approaches, the Centers for Medicare & Medicaid Services (CMS) announced on August 27 the launch of a redesigned Medicare Plan Finder tool. This new tool makes it easier for customers to compare pricing, coverage, and drug plans of Medicare, Medicare Advantage, Medigap, and Part D programs. The Plan Finder tool is