Tag Archives: CMP

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

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

ALJ Upholds OCR’s $239,800 CMP for Healthcare Provider

Photo of Lynn SessionsBy Lynn Sessions and Suchismita Pahi on Posted in Uncategorized
On January 13, 2016, the Department of Health and Human Services’ Administrative Law Judge upheld the Office for Civil Rights’ (OCR’s) civil monetary penalty (CMP) against Lincare, Inc., d/b/a United Medical (Lincare), for $239,800 in an appeal of OCR’s Health Insurance Portability and Accountability Act (HIPAA) CMPs. Lincare is a home health company that provides respiratory … Continue Reading

Health System Free Transportation Program Does Not Warrant Sanctions, Says OIG

Photo of Joel D. GottesmanBy Donna S. Clark and Joel D. Gottesman on Posted in Uncategorized
The Office of Inspector General (OIG) recently issued Advisory Opinion 15-13, addressing whether an integrated health system (Health System) was at risk for administrative sanctions under the federal anti-kickback statute or civil monetary penalty law for offering free shuttle services to patients. The OIG concluded that the proposed transportation arrangement presents minimal risk of fraud … Continue Reading

Proposed 340B Rule Would Impose Penalties for Overcharging, Plus Other Charges

Photo of Lee H. RosebushBy Lee H. Rosebush and Dena Kessler on Posted in Uncategorized
A recently-released proposed rule would impose civil monetary penalties on drug manufacturers that intentionally overcharge healthcare providers for medications purchased under the 340B Discount Drug Program. The proposed rule, if adopted, could open the door to significant financial penalties for manufacturers, even if it is the manufacturer’s wholesaler or other business partner that overcharges the … 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

Justice to Target Corporations and C-Suite Executives in the Healthcare Industry

Photo of BakerHostetlerBy BakerHostetler on Posted in Uncategorized
On Thursday, May 14, 2015, at a meeting of the American Bar Association’s Healthcare Fraud Section, Leslie Caldwell, the Assistant Attorney General for the Department of Justice (DOJ) Criminal Division, declared stamping out healthcare “fraud and holding those who commit this fraud accountable are core missions of the Criminal Division and the Justice Department.” In … Continue Reading

OIG Advisory Opinion Sheds Light on Preventive Care Exception

By Donna S. Clark and Darby C. Allen on Posted in Uncategorized
The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently issued an advisory opinion approving an arrangement whereby a licensed entity providing services under a state program for at-risk mothers and children (State Program) would provide diapers and play yards to program participants who are Medicaid beneficiaries. The advisory opinion … Continue Reading

Breaking News: CMS Delays Final Overpayment Rule

By B. Scott McBride and Darby C. Allen on Posted in Uncategorized
Today, the Centers for Medicare and Medicaid Services (CMS) announced that it is extending the deadline to finalize the rule implementing the Affordable Care Act provision that requires providers to timely report and return overpayments to the Medicare program. The proposed rule was issued in February 2012, and CMS is required to provide notice to … 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 Revamps Regulations Concerning CMPs and Exclusion

By B. Scott McBride and Darby C. Allen on Posted in Uncategorized
In a pair of proposed rules published in May, the HHS OIG unveiled changes to the regulations concerning OIG’s authority to impose civil monetary penalties (CMPs) and exclude individuals and entities from participation in federal healthcare programs. The changes are largely driven by provisions in the Affordable Care Act (ACA) and illustrate OIG’s expansion of … Continue Reading

Proposed $6.8M Fine Related to Puerto Rico Breach Incident

Photo of Lynn SessionsBy Lynn Sessions and Kimberly M. Wong on Posted in Uncategorized
Triple-S Salud, Inc. (Triple-S), a Puerto Rico Health Insurance Administration (PRHIA) contractor, filed a Form 8-K indicating that the PRHIA intended to impose a civil monetary penalty (CMP) of $6,768,000 and other administrative sanctions stemming from a breach incident affecting 13,336 dual eligible Medicare beneficiaries.  The breach incident occurred in September 2013 when Triple-S mailed to … Continue Reading
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