In a report released on February 26, 2016, the federal government announced that it recovered $2.4 billion through its Health Care Fraud and Abuse Control Program (HCFAC) during FY 2015. The $2.4 billion is almost $1 billion lower than the recovery of $3.3 billion in FY 2014. Over the last three years, the return on … Continue reading
At a recent DC Bar program called “The Use of Data by the OIG-DHHS and CMS/CPI in Medicare Program Integrity, Investigations and Compliance,” representatives from CMS and the OIG provided their perspectives on the evolving capabilities of government agencies to review and analyze large datasets related to the provision and reimbursement of healthcare services.… Continue reading
Biggest year ever for declined qui tams On December 3, 2015, the Department of Justice announced that it had recovered more than US$3.5 billion in settlements and judgments from civil cases involving fraud and false claims against the government in the fiscal year ending Sept. 30. According to DOJ’s press release, “US$1.9 billion came … Continue reading
Introduction On Wednesday September 9, 2015, the U.S. Department of Justice (“DOJ” or the “Department”) issued a memorandum entitled “Individual Accountability For Corporate Wrongdoing” (the “Memo”) outlining specific policy measures intended to empower U.S. prosecutors further in their pursuit of individuals alleged to be involved in corporate wrongdoing. The Memo is termed “guidance” by the … Continue reading
On Friday, May 22, a Detroit-area neurosurgeon accused of performing medically unnecessary spinal surgeries pleaded guilty to health care fraud in two federal criminal cases. Dr. Aria Sabat, 39, admitted Friday before U.S. District Judge Paul Borman that his participation in a physician-owned device distributorship (“POD”) caused him to compromise his medical judgment and to … Continue reading
In a report released on March 19th, the federal government stated that its Heath Care Fraud and Abuse Control Program (HCFAC) recovered $3.3 billion during FY 2014, including $2.3 billion in healthcare fraud judgments and settlements. The HCFAC reported its return on investment (ROI) to be $7.7 returned for every $1 expended over the last … Continue reading
CMS issued a notice on Friday that it will extend by one year the timeline for publication of a final rule concerning policies and procedures for reporting and returning of Medicare overpayments. This notice creates continued industry uncertainty regarding the implementation of key provisions of the Affordable Care Act and their impact on providers. Despite … Continue reading
Last Friday, CMS announced a six month extension of a temporary moratorium preventing new ambulance suppliers and home health agencies in six states from enrolling in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). The moratorium impacts providers in the metropolitan areas of Chicago, Miami, Detroit, Dallas, Houston, and Philadelphia. Federal regulations established under … Continue reading
In FY 2014, for the fifth consecutive year, the Department of Justice (“DOJ”) recovered more than US$2 billion from healthcare entities in False Claims Act (“FCA”) cases. The federal government collected a total of US$5.69 billion overall in FCA actions in FY 2014, and US$2.3 billion of that amount was from healthcare-related FCA actions, according … Continue reading
Last week, Dignity Health, a hospital system based in San Francisco, California, agreed to pay the United States US$37 million over a five-year period to settle allegations that it knowingly submitted false claims to Medicare and TRICARE in violation of the False Claims Act (FCA). The DOJ claimed that Dignity Health, one of the five … Continue reading
The Department of Justice (“DOJ”) announced that it received $3.8 billion in settlements and judgments from civil cases involving fraud against the government in the fiscal year ending September 30, 2013. According to the DOJ, the largest recoveries were related to healthcare fraud: a total of $2.6 billion. The total recoveries under the False Claims … Continue reading