Physicians must be aware that a full reporting of all adverse events, whether malpractice awards/settlements, license restrictions, hospital privilege issues, or insurance payor terminations, are set forth in a semi-public and centralized database known as the National Practitioner Data Bank (NPDB).» Read More

Considering the significant financial incentives and awards provided to whistleblowers, it should come as no surprise that there has been a marked increase in the number of health care fraud investigations commenced by federal and state agencies.  The New York State Medicaid Fraud Control Unit (“MFCU”) is one such agency and is increasingly worthy of the attention of health care practitioners who treat Medicaid patients in the state. » Read More

At a Brookings Institution event last month, Eric Hargan, Deputy Secretary of the Department of Health and Human Services (HHS), announced that the agency will be issuing proposed rules to revise federal fraud and abuse regulations that are seen as hampering care coordination and the transformation to a value-based health care system.» Read More

The Department of Justice (DOJ) obtained $2.8 billion in settlements and judgements from False Claims Act civil cases in fiscal year 2018.  Of this amount, $2.5 billion, (89%), involved recoveries from the health care industry, including drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories, and physicians. » Read More

According to the Office of Inspector General (OIG), the government’s primary civil tool for addressing health care fraud is the False Claims Act (FCA).  Most FCA cases are resolved through settlement agreements in which the government alleges fraudulent conduct and the settling parties do not admit liability. » Read More

The Office of Inspector General (OIG) recently posted a video entitled “Eye on Oversight Video: Corporate Integrity Agreements” that describes how providers accused of false claims or other health care fraud may settle their cases by entering into a Corporate Integrity Agreement (CIA) with the OIG. » Read More

The Centers for Medicare and Medicaid Services (“CMS”) Administrator Seema Verma on January 18, 2018, identified as agency priorities the modernization of the Stark Statute to reflect the move from a fee-for-service to a value and outcomes based payment under Medicare and the review of barriers created by the Stark Statute. » Read More