The federal Office for Civil Rights (OCR) reports that 2018 was a record year for HIPAA enforcement, with 10 settlements and one judgment bringing in $28.7 million in fines, easily surpassing the old … [Read more...]
COMPLIANCE
Enforcement Trends: After 2017 Decline, False Claims Act Healthcare Recoveries Bounce Back
January 21, 2019
Although the False Claims Act (FCA) remains a federal enforcement cash cow, the growth rate has fallen off in recent years, at least in the healthcare sector. But that short-term trend could be in … [Read more...]
ENFORCEMENT
Provider Fined for Not Taking Compliance Measures Required by Its CIA
January 19, 2019
Case: Nearly 10 years ago, a new Affordable Care Act rule requiring labs and other providers to investigate their credit balances for potential Medicare overpayments took effect. In 2015, Pediatric … [Read more...]
LEGISLATION
Compliance Alert: New Private-Pay Opioid Law Puts All Drug Addiction & Rehab Labs at Risk of Federal Prosecution
January 7, 2019
Recent federal legislation addressing the opioid crisis may have unintended consequences on the lab industry. The idea was to allow the feds to prosecute a certain kind of abuse banned by the … [Read more...]
ENFORCEMENT
By the Numbers: DOJ Recovers Billions in FY 2018
December 31, 2018
Year after year, the False Claims Act (FCA) remains the federal government's most valuable fraud enforcement tool. Although recovery amounts have declined slightly in the past two years, FCA … [Read more...]
Enforcement Trends: Opioid Crackdown Is Diverting Resources from Traditional OIG Enforcement Activities
December 14, 2018
The OIG won't admit it, but the opioid crackdown is diverting resources from traditional Medicare fraud and waste enforcement efforts. At least that's the most likely explanation for the dramatic … [Read more...]
OVERPAYMENTS
Rural Hospital Lab Outreach or Fraudulent Overreach?
November 23, 2018
Case: In February 2017, hospital management firm LifeBrite paid $400K to acquire a bankrupt rural outreach hospital in North Carolina with network status in Blue Cross Blue Shield North Carolina (BC). … [Read more...]
ENFORCEMENT
Opko Health, CEO Named in Pump-and-Dump Stock Fraud Scheme
November 16, 2018
Case: The U.S. Securities Exchange Commission charged billionaire drug entrepreneur Phillip Frost and his company, Opko Health, for participating in a market manipulation scheme allegedly organized by … [Read more...]
FALSE CLAIMS
Florida Doctor Jailed 5 Months for Lying to a Medicare Auditor
November 12, 2018
Lying to a Medicare auditor or otherwise obstructing a Medicare audit is a crime that can get you jailed. A 73-year-old endocrinologist specializing in diabetes management just learned that lesson the … [Read more...]
COMPLIANCE TIPS
Surviving a Medicare Audit: Warn Lab Staffers Not to Lie to Auditors
November 5, 2018
As a lab compliance director, you understand the dangers of obstructing a Medicare audit. The problem is you staff may not. So, make it clear to any staffer that may come into contact with an auditor … [Read more...]
