(January 12, 2018): The Medicare and Medicaid programs are both essential, yet costly health benefit programs sponsored in whole or in part by the Federal government. With Medicare and Medicaid costing $686 and $368 billion each year, respectively, the government has dedicated experienced investigators, auditors and prosecutors to ferret out incidents of health care fraud and… more>>
(January 8, 2018): Most physicians will progress through their entire career without ever having to respond to a complaint or investigation by their State Medical Board. Unfortunately, that isn’t always the case. An average of 4,309 physicians are disciplined each year by state licensure boards around the country.[1] A recent case aptly illustrates how a… more>>
(August 16, 2017): Earlier this summer, the U.S. Department of Justice (DOJ) executed its most extensive “health care fraud takedown” to date, initially arresting 412 licensed healthcare providers, doctors, and nurses alleged to have engaged in fraudulent conduct. As Attorney General Jeff Sessions stated at that time, “We are sending a clear message to criminals… more>>
The recently issued Resource Guide for Measuring Compliance Program Effectiveness, reconfigures the traditional formulation of the “Seven Elements of an Effective Compliance Program by making the “Screening and Evaluation of Employees, Physicians, Vendors and other Agents” an element unto itself – or the new “Seventh Element of Compliance!” The Resource Guide, a product of roundtable discussions… more>>
By Paul Weidenfeld January 23, 2017 On January 12, 2017, the Office of Inspector General published a final rule finalizing revisions to its exclusion authorities. The final rule makes changes to key definitions that could have a significant impact on providers by broadening the scope of their exclusion screening obligation and enhancing exclusion enforcement by… more>>
DOJ Announces $4.7 billion in FCA Recoveries By Paul Weidenfeld December 16, 2016 The "Third Best Year" in False Claims Act History? The Department of Justice announced earlier this week that FY 2016 was its third best year in “False Claims Act History” with recoveries of more than $4.7 billion in settlements and judgments. Though it… more>>
OIG Imposes Record $21.5 Million in Penalties for Exclusion Violations! The OIG imposed a record $21.5 million civil money penalties and restitution against an Ohio corporation that operates pharmacies and supermarkets in 34 states for exclusion violations involving the employment of excluded individuals and fulfilling prescriptions by excluded prescribers! The settlement alleged that the company filled… more>>
By Paul Weidenfeld [1] The Office of Inspector General (OIG) has steadily increased its enforcement of OIG Exclusion violations since the issuance of its Special Advisory stressing the effect of an OIG Exclusion in May, 2013. Among other things, they have created a special unit to focus specifically on Civil Money Penalties (CMPs) (its favored enforcement tool), supported numerous prosecutions… more>>
By Robert W. Liles. August 3, 2016. The False Claims Act is the primary civil enforcement tool utilized by the federal government in its fight against fraud generally, and, in particular, Medicare and Medicaid Fraud.[1] Already an extraordinarily useful statute forgovernment prosecutors both in termsof ease of use and in terms of the penalties and damages that may… more>>