Articles and Blogs

In just a few months, CMS is going to introduce significant changes to office or other outpatient visit coding guidelines. With a historic provision in the 2020 Medicare Physician Fee Schedule Final Rule, CMS will attempt to address the administrative burden placed on providers and prioritize patients over paperwork. When it comes to documentation... READ MORE

On January 9, 2020, the Department of Justice (“DOJ”) announced that it collected over $3 billion in settlements and judgments under the False Claims Act (“FCA”) in the federal fiscal year 2019. The FCA has historically been the government’s primary tool for combatting perceived fraud, waste and abuse in the health care system, and... READ MORE

On October 2, 2019, the Department of Health and Human Services (“HHS”) Office for Civil Rights (“OCR”) announced that a Texas dental practice (“Practice”) will settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) by paying a civil penalty of $10,000 and adopting a corrective action plan. A patient of... READ MORE

On July 11, 2019, the Antitrust Division of the DOJ (“Division”) announced a new initiative aimed at encouraging robust corporate antitrust compliance programs. The Division’s initiative incentivizes compliance programs by establishing that firms charged criminally for antitrust violations will be given credit in charging and sentencing recommendations if they have effective corporate antitrust compliance... READ MORE

Last week, a federal district court in Illinois entered judgment for Defendants in an FCA action against a self-proclaimed “one stop shop” health care referral management company, alleging anti-kickback and FCA violations for its arrangement with a care coordination organization for low-income seniors.[1] Originally filed in 2016, this case highlights how even an FCA... READ MORE

The DOJ’s recent revisions to its Justice Manual created a new path for self-disclosing potential fraud to the government – one which is unique in its ability to defray the costs of potential False Claims Act violations. In 2015, Deputy Attorney General Sally Quillian Yates released a memo entitled Individual Accountability for Corporate Wrongdoing, more... READ MORE

On April 30, 2019, the U.S. Department of Justice (“DOJ”) released an updated version of is guidance known as “The Evaluation of Corporate Compliance Programs” (“2019 Guidance Document”). This document provides actionable guidance for health care providers seeking to assess and enhance their compliance programs. The DOJ’s updates emphasize the government’s view that not... READ MORE

On August 27, 2018, the Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) published a Request for Information (“RFI”) regarding the Anti-Kickback Statute (“AKS”) and Civil Monetary Penalties Law (“CMP”). The RFI, published as a result of HHS’s desire to transition the current health care system to one that pays... READ MORE