Fourth Circuit Decision Addresses Constitutionality of Per-Claim Penalty under Federal False Claims Act

The decision delivered just before Christmas by the United States Court of Appeals for the Fourth Circuit in US ex rel. Kurt Bunk, et al., v. Gosselin Worldwide Moving, N.V., et al. is of value and of interest to all healthcare providers subject to the reach of the Federal False Claims Act (hereafter “FCA”). Although not […]

HIPAA Enforcement for Breach Involving Less than 500 Patients

The U.S. Department of Health and Human Services (HHS) initiated a compliance investigation after the Hospice of North Idaho (HONI) reported to HHS that an unencrypted laptop computer containing the electronic protected health information (ePHI) of 441 patients had been stolen. Pursuant to the Health Information Technology for Economic and Clinical Health Act (HITECH), if […]

New York State Legislative Bill Mandating Direct Payment To Out Of Network Clinical Laboratory Providers

The New York State Senate and Assembly have introduced a bill (S.1083/A.636) to amend the Public Health Law (Section 4406) and the Insurance Law (Section 4084), in relation to reimbursement of out-of-network clinical laboratory providers by a commercial health benefit plan. The bill would require commercial health benefit plans to make payment for laboratory services […]

Quest’s Competitors File Lawsuit for Prohibited Arrangements with National Health Plans

Over the past several years, some commercial insurers have made a concerted effort to reduce costs associated with laboratory services, which physicians have increasingly relied upon in diagnosing and treating patients. In particular, insurers are concerned with the rise in laboratory services being performed out-of-network and the increased costs associated with such claims. Despite the […]

False Claims Act: Payment vs. Participation Regulations

In U.S. ex rel. Williams v. Renal Care Group, Inc. (Case No. 11-5779) (October 5, 2012), the Sixth Circuit Court of Appeals reversed a grant of summary judgment in favor of the United States on two main False Claims Act (FCA) claims relating to Medicare reimbursement of dialysis supplies. In doing so, the Court issued […]

New York State Allegedly Overbilled $15 Billion for State-Operated Facilities for Developmentally Disabled

On May 17, 2012, the U.S. Department of Health and Human Services, Office of Inspector General (OIG) released a report that found Medicaid overpayments to New York State-operated developmental centers. The OIG concluded that, in 2009, State-operated  facilities for the developmentally disabled received $1.7 billion in Medicaid payments in excess of the reported costs of these facilities. […]

Medicaid Compliance Plans and the OMIG

As you may be aware, the New York State Office of the Medicaid Inspector General (or “OMIG”) has established that certain Medicaid providers (all Public Health Law Article 28 and 36 facilities, and all Mental Hygiene Law Article 16 and 31 facilities) have Medicaid Compliance Plans.  Also covered are providers that derive a “substantial portion […]

OSC Identifies $57 Million in Medicaid Overpayments and Missed Savings

On July 24, 2012, the office of the New York State Comptroller (“OSC”)  released the results of three separate audits which identified  a total of $33 million in Medicaid overpayments made by the New York State Department of Health (“DOH”) and an additional $24 million in missed drug rebate savings. One audit found that,  between […]

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 […]

New York City and Long Island Prosecutors Announce Prescription Drug Initiative; 98 Charged with Illegal Distribution of Prescription Pain Killers

On June 6, 2012, The United States Attorney for the Eastern District of New York, along with District Attorneys from  Kings (Brooklyn), Richmond (Staten Island), Nassau, Queens, and Suffolk counties, announced the filing of drug trafficking charges across separate cases in those jurisdictions.  In total, 98 defendants, including two doctors and one nurse practitioner were charged with illegal […]