Tag Archives: Stark Law

Former Tuomey CEO Settles with DOJ for $1 Million

By Donna S. Clark and Banee Pachuca on Posted in Uncategorized
The U.S. Department of Justice (DOJ) recently reached a $1 million settlement with Ralph J. Cox III, the former CEO for Tuomey Health System, Inc. (Tuomey), in connection with his involvement in the notable Stark Law case. After protracted litigation, Tuomey agreed to pay $72.4 million in October 2015 to settle allegations that the system had violated the … 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

The Deeper Dive: Senate Finance Committee Examining Modernization of the Stark Law

By Darby C. Allen and Donna S. Clark on Posted in Uncategorized
The Committee’s interest in the Stark Law and receptiveness to feedback from industry leaders may indicate that significant changes to the law are in the pipeline. As the healthcare industry moves from a fee-for-service (FFS) reimbursement system for physicians to a value-based payment system, industry insiders are questioning whether the federal physician self-referral law and … Continue Reading

CMS Finalizes Revisions to Stark to Ease Burden on Providers, Refines “Incident to” Requirements

Photo of Kristen McDermott WoodrumBy Kristen McDermott Woodrum, Darby C. Allen and Donna S. Clark on Posted in Uncategorized
In its calendar year 2016 Physician Fee Schedule Final Rule published in the Federal Register on November 16, 2015 (Final Rule), the Centers for Medicare and Medicaid Services (CMS) finalized amendments to the federal physician self-referral (Stark) regulations proposed in the Physician Fee Schedule proposed rule released in July. Among the significant provisions contained in the Final Rule are … Continue Reading

Proposed Rule Aims to Refine Stark Regulations and Clarify “Incident To”

Photo of Kristen McDermott WoodrumBy Kristen McDermott Woodrum and Darby C. Allen on Posted in Uncategorized
On July 15, 2015, the Centers for Medicare and Medicaid Services (CMS) published the calendar year (CY) 2016 Physician Fee Schedule Proposed Rule. In addition to updating several traditional Part B payment policies, the proposed rule contains significant changes to the physician self-referral regulations (Stark regulations) and the Medicare “incident to” coverage rule. The comment … Continue Reading

Tuomey Judgment Upheld in Novel Stark Law and False Claims Act Case

By Donna S. Clark and Darby C. Allen on Posted in Uncategorized
The U.S. Court of Appeals for the Fourth Circuit recently upheld the judgment against Tuomey Healthcare System, Inc. (Tuomey), in a qui tam False Claims Act case predicated on Stark Law violations. The district court in the case had previously upheld a jury verdict finding that Tuomey, a community hospital in South Carolina, violated the … 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

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

Stark Law Update: All Children’s Settles False Claims Act Allegations

By Donna S. Clark and Darby C. Allen on Posted in Uncategorized
All Children’s Health System (ACHS) will pay the federal government and state of Florida $7 million to settle allegations that it violated the federal and Florida False Claims Act statutes by submitting claims to Medicaid that were illegal under the Stark Law. The whistleblower in the case was the Director of Operations of Pediatric Physician … Continue Reading

Halifax Reportedly Settles Landmark Stark Case

By Donna S. Clark and Darby C. Allen on Posted in Uncategorized
According to minutes filed in the U.S. District Court for the Middle District of Florida, Halifax Hospital Medical Center (Halifax) and the U.S. Department of Justice (DOJ) have reached a settlement in the pending False Claims Act case in which Halifax is accused of entering into financial relationships with medical oncologists and neurosurgeons in violation … 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
LexBlog