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CMS Puts Out New Physician Self-Referral Disclosure Protocol

If you’re a healthcare provider or supplier, take note. Starting June 1, 2017, there is a new process for self-reporting actual or potential violations of the Stark Law to the Centers for Medicare & Medicaid Services. Remember, Stark says that doctors can’t refer certain, designated health services that are payable by Medicare or Medicaid to entities in which they have a financial interest. Read More

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Double, Triple Whammies and Rewards

Speaking of the False Claims Act, get ready to buckle up. Starting Monday, an interim final rule by the U.S. Justice Department will nearly double the statute’s civil monetary penalties for each false claim. The minimum penalty will go from $5,500 to $10,781, and the maximum penalty will go from $11,000 to $21,563. For defendants, this means you’re looking at a Read More

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The Scope of Fraud for Government Contractors

This summer, the U.S. Supreme Court issued an important decision for government contractors and the whistleblowers who sue them under the federal False Claims Act. The bottom line may be this: contractors must abide by a myriad of rules, regulations, and contractual provisions in doing business with the government, but if they don’t, not every misstep, only the material ones, can Read More

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SCOTUS Stands Up for the Sixth Amendment

We’ve asked this question before. What if the government charged you with a crime, and you wanted to defend yourself but couldn’t—not because you didn’t have any money, but because the government had blocked all access to it? Twenty-five years ago, the U.S. Supreme Court said the government can freeze your money before trial if there’s probable Read More

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CMS Issues Final “Overpayments” Rule for Medicare Parts A and B

Speaking of healthcare—providers, suppliers, and other stakeholders should take note that, last week, the Centers for Medicare & Medicaid Services (CMS) published its long-awaited final rule for reporting and returning overpayments under Medicare Parts A and B. The rule defines “overpayments” to include any funds you receive or retain that you’re not entitled to after applicable reconciliation. The CMS published its rule for Medicare Read More

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Federal Healthcare Fraud Is A Continuing Offense

Which means the statute of limitations won’t matter if the government can characterize your conduct as one, continuous scheme that extended into the limitations period. So held a decision last week by the U.S. Court of Appeals for the Ninth Circuit, which covers California and eight other states. The decision affirmed a podiatrist’s conviction for violating the federal healthcare Read More

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Medicare’s New Fraud Prevention System Begins to Yield Savings

This summer not only marked the 50th anniversary of the birth of our national Medicare and Medicaid programs; it also marked the fourth anniversary of the launch of Medicare’s experiment with predictive analytics, and it delivered some report cards on the system’s third full year of implementation and use. The Fraud Prevention System (FPS), as it’s called, was legislated into Read More

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Another Massive Medicare-Fraud Roundup

In case you missed it, two weeks ago, the federal Medicare Fraud Strike Force announced a nationwide sweep that ensnared 243 people for their alleged participation in fraudulent schemes to bill Medicare over $700 million. The individual cases are not all related, but the coordinated takedown was the largest we’ve seen so far—both in the number of targets and in the Read More

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You Can Go Your Own Way

Go your own way, if you must, but in whistleblower cases, it’s better to have a partner, especially when that partner is the Department of Justice. Under the whistleblower, or qui tam, provisions of the False Claims Act, citizens may sue on behalf of the government, and if they do, they stand to collect anywhere from 15-30% of the recovery. That can Read More

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An Active Forecast for Healthcare Enforcement

Here is a good summary of the state of affairs when it comes to healthcare fraud and compliance. The bottom line is it continues to be a high priority for government. The highlights? Follow the money. For fiscal year 2015, Congress more than doubled the funding of the government’s Health Care Fraud and Abuse Control program to $672 million. The HCFAC, as it were, was created Read More

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