With Medicaid spending on the rapid ascent, CMS unveiled a trio of new initiatives to bolster program integrity and make states more accountable for compliance with federal rules. 1. MLR Audits CMS … [Read more...]
COMPLIANCE
Enforcement Trends: New Fraud Takedown Focuses on Opioid Drugs & Sophisticated Financial Schemes
July 13, 2018
The 2016 health care fraud takedown was the biggest in history; the 2017 version surpassed it; and the June 2018 reprise nearly doubled the 2017 effort, at least in terms of the false claims dollars … [Read more...]
DOJ
Criminal Charges May Spell the End for Theranos
July 13, 2018
Four years ago, Theranos was a $10 billion company poised to turn a breakthrough blood testing technology into a diagnostics dynamo to the tune of $70 billion in annual sales. Today, the company … [Read more...]
HEALTH CARE REFORM
ACA: DOJ Won’t Defend Individual Mandate in Court—But 16+ States Will
June 18, 2018
One of the DOJ's principal roles is to defend the federal laws in court cases challenging their constitutionality. But the agency has made it known that it will not be doing that in a lawsuit brought … [Read more...]
ENFORCEMENT
Case of the Month: $33.2 Million Alere Settlement Sends Warning Shot Across Bow of LDT & DX Device Makers
April 23, 2018
One of the reasons Abbott Laboratories got cold feet about consummating the $5.3 billion Alere acquisition was concern over the legal proceedings against the target firm. Now one of those cases … [Read more...]
COMPLIANCE
Physician Referrals: New Rules Offer Some Stark Law Relief but Not Nearly Enough
April 11, 2018
Like most budget bills, the new federal Bipartisan Budget Act of 2018 includes a number of changes to Medicare fraud and enforcement requirements. One set of changes affects the current physician … [Read more...]
FOCUS ON
New Laws: Very Quietly, Congress Doubles Penalties for Medicare Fraud & Abuse
April 10, 2018
Sneaky may be too strong a word. But what is fair to say is that the new hikes in federal health care fraud violation penalties have flown totally under the radar despite their obvious and immediate … [Read more...]
FOCUS ON
DOJ to Prosecutors: Show Tough Love to Whistleblowers with Weak Cases
March 19, 2018
A newly leaked internal Justice Department memo signals a new prosecution policy that may make it harder for whistleblowers to bring qui tam whistleblower lawsuits under the False Claims Act (FCA). … [Read more...]
ENFORCEMENT TRENDS
New Fraud Takedown Shows that Coordinated Enforcement Remains Alive & Well under Trump
July 31, 2017
Last year at this time, the Justice Department announced the results of a nationwide takedown involving "the most defendants charged and largest alleged loss amount in Medicare Strike Force … [Read more...]
DOJ
Medical Necessity Requirement Bites Anatomic Pathologists
June 6, 2017
By Robert Mazer bio The DOJ has announced two separate settlements involving claims for allegedly unnecessary special stains. Medicare permits a pathologist to order special stains when … [Read more...]
