Tuomey Healthcare System Inc. owes the government $237.4 million after losing its Fourth Circuit appeal of a judgment imposed after a jury found the hospital liable for violations of the Stark self-referral law and the False Claims Act.
Tuomey has
CMS releases 2014 Sunshine Act data
On schedule, CMS released the 2014 Sunshine Act data, which shows $6.49 billion in transfers of value by pharmaceutical and medical-device manufacturers to physicians and teaching hospitals. The data covers 11.4 million financial transactions attributed to over 600,000 physicians
Obamacare saved by Supreme Court
In a 6-3 decision credited with saving Obamacare, the Supreme Court ruled on Thursday that the premium subsidies offered to qualifying enrollees of insurance plans offered on federal exchanges, which help more than 6 million Americans pay for their health
Two new OIG reports signal intensified scrutiny on Medicare Part D fraud
On the heels of the largest nationwide health care fraud takedown in history announced last week, the federal government on Tuesday issued two new reports detailing what it believes to be extensive evidence of suspicious billing under Medicare Part D.
Feds unveil sweeping Medicare fraud “takedown”
On June 18, Federal officials announced criminal enforcement actions against 243 individuals across the country. The nationwide arrests mark the largest criminal health care fraud takedown in history and came as a result of Medicare Fraud Strike Force investigations. The
Government gears up: Sunshine data informs investigations and inquiries
This week at an enforcement panel, government representatives discussed using the Sunshine Act data to delve into allegations of kickbacks to doctors and detect industry trends of improper behavior.
During the American Conference Institute’s 7th Annual Forum on Sunshine Act
OIG cautions physician compensation must reflect only FMV for bona fide services provided
In its June 9, 2015 Fraud Alert, the OIG cautions that physician compensation arrangements must reflect only the fair market value for bona fide services that physicians actually provide. Even legitimate compensation arrangements may violate the anti-kickback statute if
Data refresh: CMS releases 2013 hospital and physician payment information
CMS has released data sets showing payments to hospitals and physicians for calendar year 2013: the same calendar year as the Sunshine Act data released last fall. As a result, various sources will have contemporaneous data that could be used
Neurosurgeon’s $11M Guilty Plea Illustrates Potential Dangers of PODs
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
Broad interpretation of France’s Sunshine Act continues global trend toward transparency
Beyond the United States’ Physician Payments Sunshine Act reporting requirements, international pharmaceutical and device companies must account for a growing number of transparency requirements related to their interactions with healthcare professionals.
For example, in France, the Bertrand Act requires transparency