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Hospitals and Health Systems – Fraud and Abuse

Feb 07, 2019

Stark and Antikickback Statute Reforms on the Way?

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

Jan 16, 2019

DOJ Recovers $2.8 Billion in 2018 False Claims Act Cases

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

Oct 17, 2018

Exclusion Implications of Entering into False Claims Act Settlements

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

May 31, 2018

OIG Video on Corporate Integrity Agreements

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

Mar 12, 2018

Stark and Payment Reform in 2018?

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

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