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.

New OIG Fraud Alert Focuses on Compensation of Medical Directors

The United States Department of Health and Human Services Office of Inspector General (“OIG”) issued a short Fraud Alert last week focusing on the anti-kickback implications of certain compensation paid to medical directors. OIG noted that it had recently settled with a dozen physicians who had entered into medical director positions of various health care […]

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 […]

Proposed Rule to Extend and Amend the Exception to Donate Electronic Health Records Items and Services

The Office of Inspector General for the Department of Health and Human Services (OIG) and the Centers for Medicare and Medicaid Services (CMS) published on April 10, 2013 proposed rules to extend and amend the Electronic Health Records (EHR) donation exceptions under the Anti-Kickback Statute and Stark Law, respectively. The proposed rules would extend the […]

OIG: PODs “Inherently Suspect”

On Tuesday, the federal Office of the Inspector General (“OIG”) issued a Special Fraud Alert (“Fraud Alert”) detailing the OIG’s concerns with Physician-Owned Entities.  Specifically, the alert dealt with physician-owned distributorships, or PODs.  PODs are typically entities that make money by selling or arranging for the sale of implantable medical devices. The United States Senate […]

Legal Hurdles Mount for Lab Corp and Quest

The U.S. Department of Justice (DOJ) and the Federal Trade Commission (FTC) recently released their Annual Report for Fiscal Year 2011 under the Hart-Scott-Rodino Antitrust Act. In brief, the Hart-Scott-Rodino Act allows the DOJ and FTC to block transactions believed to be harmful to competition and consumers. The Annual Report reviews the enforcement activities undertaken by these […]

The Wild, Wild West of Billing by Out-of-Network Labs and Waivers of Patient Responsibility

O’Connell & Aronowitz attorneys, Jeffrey Sherrin, Kurt Bratten, and Charles Dunham, spoke at a national meeting of clinical laboratories in Las Vegas on May 19, on the complicated issue of referrals to and billing by out- of-network (OON) clinical laboratories, and the waiver of patient responsibility.  Waivers of copays, deductibles and balance billing have been used […]

OIG Releases Advisory Opinion on Physician Investments in Pathology Laboratory Management Services Company

The U.S. Department of Health and Human Services, Office of Inspector General (OIG) recently issued an Advisory Opinion (AO 11-15) on a proposed arrangement relating to a physician investment in a pathology laboratory management services company.