The next round in United States ex. rel. Drakeford v. Tuomey Healthcare System, Inc., is underway and Tuomey Healthcare keeps fighting. As previously reported, on May 8, 2013, a federal jury found that Tuomey Healthcare System, a non-profit system in South Carolina, violated the Stark law and the False Claims Act in connection with its compensation structure for … Continue Reading
In the ongoing saga of U.S. ex. rel. Drakeford v. Tuomey Healthcare System, Inc., on May 8, 2013, a South Carolina jury found that Tuomey violated the Stark Law and the False Claims Act. The jury determined that Tuomey submitted over 21,000 improper claims, totaling $39 million. When penalties and treble damages of up to $11,000 per claim are … Continue Reading
I have a vivid memory of sitting next to my father in an elementary school principal’s office. The facts were: (1) three “student of the week” ice cream vouchers had gone missing from my teacher’s desk; (2) I was a somewhat portly child; and (3) I had tried, albeit unsuccessfully, to cash in one of those illicit vouchers at … Continue Reading
The Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services’ (OIG) have issued a pair of proposed rules (see CMS rule, OIG rule) that seek to revise the current Electronic Health Records exceptions to the Physician Self-Referral (Stark) and Anti-Kickback laws.
The proposed rules would amend the current … Continue Reading
Two healthcare cases announced during the first week of April, 2013, vividly illustrate the uncertainty of how much a violation of applicable healthcare statutes or regulations might cost a provider.
On March 26, 2013, the Department of Health and Human Services Office of Inspector General (OIG) issued a Special Fraud Alert advising that the OIG considers physician-owned distributorships (“PODs”) as “inherently suspect” under the federal Anti-Kickback Statute. In the strongly worded guidance, the OIG defines PODs as physician-owned entities that sell or arrange for the sale of implantable medical devices … Continue Reading
In 2009, the Health Care Fraud Prevention and Enforcement Action Team (“HEAT”) initiative was formed as a joint effort between the Departments of Justice and Health and Human Services, and combating health care fraud continues to be a major focus of federal and state authorities. The Office of Inspector General (“OIG”) publishes a list of the criminal and civil enforcement … Continue Reading
In January, a Federal District Court in Oklahoma issued a ruling in favor of a former marketing representative of a medical equipment distributor. The Court determined that Gary Weaver was, in fact, engaged on an independent contractor basis, not as an employee, and therefore his employment agreement with Joint Technology, Inc. was an unenforceable illegal contract under the Federal Anti-Kickback… Continue Reading
Historically, federal and state regulations designed to control healthcare costs have focused on preventing fraud and abuse and self-referrals. Prior to adoption of the Patient Protection and Affordable Care Act in 2010, the Anti-Kickback Statute and the Stark Law were probably the most frequently referenced healthcare statutes. Both of these statutes, which have been in effect for more than 20 … Continue Reading