Category Archives: Fraud & Abuse & False Claims Act

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Regulatory Roulette: How Much Will A Violation Of The Healthcare Statutes Cost You? The Answer Is Not Always Clear

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 April 3, 2013, the Department of Justice announced that Intermountain Health Care, Inc., which operates the largest health system in Utah, had agreed to pay the United States … Continue Reading

New OIG Special Fraud Alert Declares PODs To Be “Inherently Suspect”

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

Recent Criminal and Civil Enforcement Actions

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

Court Determines Whether Marketing Rep Was Really a Bona Fide Employee

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

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Controlling Healthcare Costs-A New Direction

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