SCOTUS Decides Implied Certification Issue in Key False Claims Act (Whistleblower) Case

In a decision that is poised to have resonating implications for health services providers, the Supreme Court of the United States explicitly endorsed the “implied false certification theory of liability” under the False Claims Act (FCA) in Universal Health Services, Inc. v.  U.S. ex rel. Escobar.  Under this theory of liability, any person who submits […]

Further Analysis of 60-day Medicare Overpayment Rule Reveals Emphasis on Proper Compliance Plans

Last week, we highlighted that the Centers for Medicare and Medicaid Services (“CMS”) released a long-awaited final rule regarding its interpretation of the statutory obligation of Medicare Part A and Part B providers to return any overpayments they receive from the program within 60 days after such an overpayment is “identified.”  The final rule is […]

CMS Releases Final Rule on 60-day Medicare Overpayment Reporting Obligations

This morning, the Centers for Medicare and Medicaid Services (“CMS”) made available a copy of a final rule clarifying the obligations of providers and suppliers to report and return Medicare overpayments within 60 days after the date on which the overpayment was identified.  The final rule will be published in tomorrow’s Federal Register.

CMS Solicits Comments on New Antikickback Safe Harbors

The Centers for Medicare and Medicaid Services (“CMS”) is soliciting topics for new safe harbors and special fraud alerts.  The solicitation appeared in the December 23, 2015 Federal Register, and is made each year. Interested commenters have 60 days to submit their proposals.  The solicitation may be viewed here.

Office of the State Comptroller Issues Medicaid Program Integrity Report

The New York State Medicaid program is projected to have a $62 billion-dollar price tag in State Fiscal Year 2016, with $22.4 billion paid out by the State, as explained by the New York State Office of the Comptroller (“OSC”) in its April 2015 report entitled Ensuring Integrity in New York State Medicaid.   As Medicaid […]

Medicare Reimbursement Standards Take Center Stage in Dismissal of False Claims Act Case

Our monthly Health Law Update from the Albany County Bar Association Newsletter has been released a few days early.  This month’s article discusses a Georgia federal court decision granting summary judgment to a nursing home and a rehabilitation therapy provider in a Federal False Claims Act prosecution that alleged the unnecessary provision of rehabilitation therapy services. Although the […]

Seventh Circuit Decision Highlights Scope of Anti-Kickback Statute

This month’s article from the Albany County Bar Association Newsletter offers brief summary of the recent decision in U.S. v. Patel, in which a physician was found to have violated the federal Anti-Kickback statute for an improper referral scheme with a home health agency, even though he did not actively divert patients to other providers. The […]

US DOJ Sets New Record for Fraud and False Claims Recoveries in FY2014

As 2014 comes to a close, the United States Department of Justice (“DOJ”) has many reasons to celebrate as it reflects on the year that was. In FY2014, the DOJ recovered $5.69 billion in settlements and judgments resulting from civil fraud and false claims cases, with $2.3 billion in health care fraud recoveries alone. This […]

The Rise of the Worthless Services Theory in Federal False Claims Act (Whistleblower) Cases – A Look to the Future

The theory of “worthless services” has yet again been tried by whistleblowers in the federal False Claims Act context, this time resulting in a large settlement with the federal government.  We saw this argument made previously in Ashber v. Momence, which we discussed in a prior article here.  Now, Extendicare Health Services Inc., and its […]

Attention Medicaid and Medicare Providers: US DOJ Sues Providers for Failing to Return Overpayments Within 60 Days

On June 27, 2014, in the case of United States ex rel. Kane v. Healthfirst, Inc., et al., No. 11-2325 (S.D.N.Y.), the United States Department of Justice (USDOJ), via the United States Attorney’s Office for the Southern District of New York, sued several Medicaid providers under the federal False Claims Act for failing to return […]