Corporate Integrity Agreement Highlights Individual Accountability within Health Care Organizations

A physician-owned chain of family medicine clinics located in and around Columbia, South Carolina, Family Medicine Centers of South Carolina, LLC (“FMC”), has agreed to pay the United States $1.56 million, and its principal owner and former chief executive officer, Dr. Stephen F. Serbin, and its former Laboratory Director, Victoria Serbin, have agreed to pay $443,000, to resolve a False [...]

By |2017-11-08T10:10:41-07:00October 13, 2017|

Understanding “Incident To” Billing

Section 1861(s)(2)(A) of the Social Security Act allows physicians to bill Medicare for patient services provided “incident to” a physician’s services. “Incident to” services are furnished incident to physician professional services in the physician’s office or in certain other locations.  These services are typically performed by non-physician practitioners (NPPs), such as a nurse practitioner or physician’s assistant.  The services, which [...]

By |2017-06-09T14:03:09-07:00June 1, 2017|

Lance Armstrong, the False Claims Act and $100 Million

If you had told me five years ago that someday a qui tam case would be filed against Lance Armstrong for his use of performance enhancing drugs (PEDs) while a member of the United States Postal Service (USPS) professional cycling team, and that the case would provide insight into the government’s theories of liability under the False Claims Act (FCA), [...]

By |2017-03-17T09:11:47-07:00March 17, 2017|

Ethical Dilemmas for Attorneys in the Wake of the Yates Memorandum

Dear Colleagues, I wanted to share an article that one of our respected attorneys wrote that I think you will find of interest. Meghan Pound, experienced health care attorney with Caplan and Earnest, recently published this insightful article on the Yates Memorandum for Fraud and Abuse, a publication of the American Health Lawyers Association Fraud and Abuse Practice Group. Meghan [...]

By |2016-12-27T11:06:20-07:00July 27, 2016|

CMS Finalizes 60-Day Overpayment Rule: Providers Must Refund Overpayments Going Back Six, Not 10 Years

CMS has finalized a rule that defines the statutory obligation of providers and suppliers (“Providers”) to return Medicare overpayments (the “60-Day Rule”). The Affordable Care Act compels providers to return overpayments within 60 days of identifying them. Failing to refund overpayments can result in liability under the False Claims Act. That means a Provider could either face financial penalties or [...]

By |2016-12-27T11:06:27-07:00February 12, 2016|

Tuomey Healthcare Systems Hit with $237 Million Judgment for Stark Law Violations

Earlier this month, nonprofit hospital Tuomey Healthcare Systems, which serves an underserved rural South Carolina community, was handed a “likely death sentence” judgment of $237 million owed for Stark Law violations. The Fourth Circuit Court of Appeals affirmed the decision, which may have unsettling ramifications for physician compensation for all hospitals. In the original case appealed in United States Drakeford [...]

By |2016-12-27T11:06:37-07:00July 14, 2015|

False Claim Act Liability for Worthless or Substandard Care in Long Term Care

Late last year, the United States Department of Justice announced that Extendicare Health Services, Inc., which operates skilled nursing facilities, agreed to pay $38 million to the federal government and eight states to settle False Claim Act (FCA) allegations brought by two whistleblowers.  One of the whistleblowers in the Extendicare case was a former employee whose claims included upcoding of [...]

By |2016-12-27T11:06:40-07:00March 23, 2015|

DOJ Reports Record Year for False Claims Recoveries

The U.S. Department of Justice continues to focus on fraud and false claims against the government, announcing it obtained a record $5.69 billion in settlements and judgments from civil cases in the fiscal year ending Sept. 30, 2014. Acting Associate Attorney General Stuart F. Delery and Acting Assistant Attorney General Joyce R. Branda for the Civil Division recently announced the [...]

By |2016-12-27T11:06:53-07:00December 16, 2014|

Effective Peer Review: Preventing Fraud and Abuse in Health Care

Health care fraud is a significant problem in the United States and it’s a growing target for the Department of Justice, which estimates that such fraud costs the country $80 billion per year. The increased emphasis on abuse in the system puts hospitals and health care providers at greater risk of liability, stressing the need for effective and rigorous peer [...]

By |2016-12-27T11:06:58-07:00October 14, 2014|

DOJ Shifts to Criminal Charges for Health Care Fraud Claims

The Department of Justice (DOJ) recently announced it is going to put more teeth into investigations of health care fraud claims, saying it will immediately relay all whistleblower lawsuits to the criminal division in addition to the normal process of referring these matters to the civil division for investigation.  The announcement was made in remarks by Assistant Attorney General Leslie [...]

By |2016-12-27T11:06:58-07:00October 8, 2014|