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 […]

Applicability of Fraud and Abuse Rules to the Marketplace Clarified … Somewhat

One of the lingering questions about the Health Insurance Marketplace created under the Affordable Care Act is whether plans on the Marketplace are considered part of a Federal health care program, thus opening up potential liability under the Anti-Kickback Statute. There was concern that the broad language defining a “Federal health care program” would apply […]

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 […]

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 […]

OMIG 2012-2013 Work Plan: A Brief Overview

“Fighting Fraud.  Improving Integrity and Quality.  Saving Taxpayer Dollars.” This phrase appears on each page of the newly released New York State Office of the Medicaid Inspector General (OMIG) State Fiscal Year 2012-2013 Work Plan. On the Executive Summary page, the OMIG’s stated mission is to “enhance the integrity of the New York State Medicaid […]

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.

Federal Qui Tam Complaint Charges LabCorp with Improperly Billing the Medicare System Billions

A federal judge in New York’s Southern District Court recently unsealed a federal qui tam complaint alleging that Laboratory Corporation of America violated the federal False Claims Act by providing kickbacks to UnitedHealthcare in the form of highly reduced prices on tests.  More specifically, the suit claims prices on tests were a third to half […]

Senators Request Investigation of Physician Owned Distributorships

On June 9, 2011, five prominent United States senators sent a letter to the Inspector General of the Department of Health and Human Services (HHS) asking that a probe of physician-owned distributorships be conducted. The Senators who signed the letter include Orrin Hatch (R., Utah), Max Baucus (D., Mont.), Herb Kohl (D., Wis.), Charles Grassley […]