Tag Archives: anti-kickback law

Physicians in the Bulls-eye

Photo of Robert M. WolinBy Robert M. Wolin on Posted in Uncategorized
Several recently reported cases highlight the growing risk physicians face if they succumb to competitive pressures, especially offers of remuneration from labs, pharmacies, home health agencies and other providers to whom they refer. In many cases, the effort to recoup fees may come years after the physician received and spent the fees, with no insurance … Continue Reading

Destination Medicine: Not Just for the Rich and Famous

Photo of Katy ApplebyBy Katy Appleby and Banee Pachuca on Posted in Uncategorized
OIG okays providing modest hotel and meal accommodations for rural and financially needy patients. The U.S. Department of Health and Human Services Office of Inspector General (OIG) recently issued an advisory opinion interpreting the finalized rules related to the beneficiary inducement civil monetary penalties (CMP) law. In a previous blog post, we discussed the OIG … Continue Reading

Providers Breathe Sigh of Relief with New Anti-Kickback Safe Harbors and CMP Exceptions

By Darby C. Allen on Posted in Uncategorized
On December 7, 2016, the HHS Office of Inspector General (OIG) finalized a set of rules first proposed in 2014 adding new anti-kickback law safe harbors and protecting additional conduct from enforcement under the civil monetary penalties (CMP) law related to beneficiary inducements. The OIG’s stated purpose in adopting the rule is to allow greater … Continue Reading

Dialing for Dollars Yields Conviction for Home Health Telemarketer

Photo of Robert M. WolinBy Robert M. Wolin on Posted in Uncategorized
Sundae Williams, the owner of Serenity Marketing Inc., made unsolicited phone calls to recruit patients, including Medicare beneficiaries, for contracted home health agencies. Williams and Serenity then referred those patients to the home health agencies in exchange for payments on a per-patient basis. Williams was convicted on one count of conspiracy and six counts of … Continue Reading

Summer Fraud and Abuse Roundup

By Banee Pachuca and Darby C. Allen on Posted in Uncategorized
Now that the kids are back in school and summer vacations are in the rearview mirror, it’s time to catch up on recent fraud and abuse developments. The federal government was busy this summer negotiating a pair of settlements under the Stark Law and anti-kickback statute, drafting changes to the Self-Referral Disclosure Protocol (SRDP), and … Continue Reading

Kickbacks and Commercial Bribery: Another Touchstone to Consider

Photo of Robert M. WolinBy Robert M. Wolin on Posted in Uncategorized
The latest indictment confirms that fraud and abuse analysis is about more than just the federal and state healthcare anti-kickback statutes. The U.S. Attorney for the Northern District of New Jersey has just charged the 26th doctor and 39th person for accepting bribes from Biodiagnostic Laboratory Services in exchange for the wrongful referral of federal … Continue Reading

Drug Manufacturer Discount Cards: Accept With Caution

Photo of Robert M. WolinBy Robert M. Wolin on Posted in Uncategorized
Pharmaceutical manufacturer discount card usage by government program beneficiaries has been an active area for government action in recent years.  In a September 2014 Special Advisory Bulletin, the U.S. Department of Health and Human Services, Office of Inspector General (OIG) stated, “[t]hese coupons constitute remuneration offered to consumers to induce the purchase of specific items.” … Continue Reading

Solicitation of New Safe Harbors and Special Fraud Alerts

Photo of Robert M. WolinBy Robert M. Wolin on Posted in Uncategorized
The U.S. Department of Health and Human Services Office of Inspector General (OIG) recently announced its annual solicitation of proposals and recommendations for developing new, and modifying existing, safe harbor provisions under the federal anti-kickback statute as well as for developing new OIG Special Fraud Alerts. The criteria used by the OIG to determine whether … Continue Reading

HHS OIG Creates New Taskforce to Pursue Civil Monetary Penalties and Exclusions

Photo of BakerHostetlerBy BakerHostetler on Posted in Uncategorized
If you have any questions concerning this article, please contact: B. Scott McBride at smcbride@bakerlaw.com or 713.646.1390; Greg Saikin at gsaikin@bakerlaw.com or 713.646.1399 from our Healthcare Investigation and Enforcement team; John J. Carney at jcarney@bakerlaw.com or 212.589.4255; George A. Stamboulidis at gstamboulidis@bakerlaw.com or 212.589.4211 from our White Collar Defense and Corporate Investigations team; or Hilary … Continue Reading

OIG Advisory Opinion 15-07: An Indicator of Clinical Trial Copayment Change?

By Payal Cramer and Greg Fosheim on Posted in Uncategorized
“You scratch my back, I scratch yours” arrangements are common in business transactions. These agreements are risky in the healthcare space, however, with the potential to implicate civil and criminal sanctions. Whether involving a patient, provider, or industry, the government closely scrutinizes quid pro quo arrangements when the government foots the bill. Clinical trial sponsors … Continue Reading

OIG Fraud Alert Cautions Against Sham Medical Director Arrangements

By Donna S. Clark and Darby C. Allen on Posted in Uncategorized
The HHS OIG recently issued a brief fraud alert (Fraud Alert) reminding physicians that inappropriate compensation arrangements may lead to enforcement actions under the federal anti-kickback statute and Civil Monetary Penalties Law. Although not mentioned in the Fraud Alert, improper compensation arrangements also raise issues under the federal self-referral law known as the Stark Law. … Continue Reading

Seventh Circuit Upholds Physician’s Conviction for Violation of the Anti-kickback Law Based on Expansive Definition of “Referral”

By Nita Garg on Posted in Uncategorized
On February 10, 2015, the U.S. Court of Appeals for the Seventh Circuit upheld the conviction of Dr. Kamal Patel for violation of the anti-kickback law, reinforcing a broad definition of “referring” under the statute (U.S. v. Patel, Seventh Circuit Court of Appeals, No. 14-2607, Feb. 10, 2015). Dr. Patel, a physician who often prescribed … Continue Reading

OIG Proposed Anti-Kickback Safe Harbors and CMP Regulations: The End of Frustration or Just the Beginning?

By Donna S. Clark and Darby C. Allen on Posted in Uncategorized
On October 3, 2014, the U.S. Department of Health and Human Services Office of Inspector General (OIG) published an unexpected, yet long-awaited, set of proposed rules that would add new anti-kickback law safe harbors, protect additional conduct from enforcement under the civil monetary penalties (CMP) law related to beneficiary inducements and create a new gainsharing … Continue Reading

OIG Issues Special Advisory Bulletin Covering Manufacturer Copay Coupons and Medicare Part D

Photo of Lee H. RosebushBy Lee H. Rosebush and Dena Kessler on Posted in Uncategorized
For years, many drug manufacturers have issued coupons to help cover some or all of the cost of copayments (commonly referred to as a “copay”) for prescription medications.  While the Department of Health and Human Services (HHS) Office of Inspector General (OIG) has previously provided some guidance on the use of these coupons, there has … Continue Reading

Implications on Pharmacies of Recent OIG Advisory Opinion on Per-Fill Fees

Photo of Lee H. RosebushBy Nita Garg and Lee H. Rosebush on Posted in Uncategorized
The U.S. Department of Health & Human Services, Office of Inspector General (OIG) recently issued an advisory opinion regarding a proposed arrangement by a specialty pharmacy (Requestor) to pay local pharmacies a per-fill fee for the provision of support services in connection with patient referrals to the specialty pharmacy. OIG found that this per-fill fee … Continue Reading

Summer Fraud and Abuse Roundup

By Darby C. Allen, Donna S. Clark and B. Scott McBride on Posted in Uncategorized
The federal government was busy over the summer when it came to decisions and settlements under the Stark Law, anti-kickback law and federal False Claims Act. This article revisits recent developments with respect to healthcare fraud and abuse. Group Practice Pays Over $1 Million for Improper Compensation Formula The New York Heart Center, a cardiology … Continue Reading

Government Sues Hospital for Birthing Mama’s Babies

Photo of Robert M. WolinBy Robert M. Wolin on Posted in Uncategorized
The Clinica de la Mama case could well serve as an instruction manual of what not to do to stay out of the government’s crosshairs. In this case, several hospitals entered into contracts for Clinica de la Mama to provide “services” including translation, translation management, consulting, eligibility determination, marketing, birth certificate, educational, community outreach and … Continue Reading

Do You Know What Your Hospital Board Members Are Doing?

Photo of Robert M. WolinBy Robert M. Wolin on Posted in Uncategorized
David Chandler was appointed to serve as chairman of Tri-Lakes Medical Center (TLMC), a community hospital in Panola County, Mississippi. As chairman, Chandler set board meeting agendas, regularly dealt with the administrator and communicated with department heads to obtain various reports. Chandler also arranged for the hospital’s administrator to meet with a nurse staffing company. … Continue Reading

A Look Back at 2013

Photo of BakerHostetlerBy BakerHostetler on Posted in Uncategorized
In this posting: A Look Back at 2013 Antitrust and Competition Policy, Advocacy and Legislative Strategy Development FDA and Life Sciences Privacy and Data Protection Enforcement and Compliance Transactions and Finance Reimbursement, Licensing and Certification Fraud and Abuse Laws Tax-Exempt Organizations Honors and Recognition Was it the number 13? There’s an old superstition about the … Continue Reading

OIG and CMS Extend Expiration Date for EHR Donations

By Donna S. Clark and Darby C. Allen on Posted in Uncategorized
As the final days of 2013 passed and the sunset of the Stark Law exception and anti-kickback law safe harbor for electronic health record (EHR) donations loomed nearer, the U.S. Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) and Office of Inspector General (OIG) issued last-minute final regulations to … Continue Reading

Federal Judge Dismisses All Anti-Kickback Claims in Halifax Hospital Medical Center Case

By Donna S. Clark and Darby C. Allen on Posted in Uncategorized
On January 8, 2014, the U.S. district judge in the Halifax Hospital Medical Center (Hospital) case pending in the Middle District of Florida granted the Hospital’s motion to dismiss all of the relator’s anti-kickback law claims. This False Claims Act case is partially predicated on alleged violations of the Stark Law and the anti-kickback law … Continue Reading
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