You can’t make this stuff up. When CMS conducted a study to identify hospitals that game the quality data reporting system, it used an approach that made the data reporting look better than it actually was. That bottom line is indicated in the second half of the title of a May 4 study released by the Office of …
The Downside of the Advice-of-Counsel Defense
April 19, 2017 Leave a Comment
Intent is a necessary element of a False Claims Act (FCA) violation. If a defendant reasonably relied on advice of counsel in performing the actions at issue, the intent element is absent. That’s the upside of the advice-of-counsel defense. But there’s a downside, and a recent federal decision in a major …
Unplanned EHR Disruptions–Common for Hospitals
July 28, 2016 Leave a Comment
The prevalence of ransomware attacks is increasing. In fact, “[o]n average, more than 4,000 ransomware attacks have occurred daily since January 1, 2016,” according to a recent interagency government report. Given this known threat, contingency planning by hospitals becomes even more important. This …
New Guidance on Exclusion
April 19, 2016 Leave a Comment
For the first time in nearly 20 years the Office of Inspector General (OIG) of the Department of Health & Human Services has issued new guidance on the exercise of its authority to exclude health care providers from participating in federal health care programs, including Medicare, Medicaid, and Tri-Care. …
Health Care Fraud and Abuse Enforcement Priorities in Minnesota
March 7, 2016 Leave a Comment
United States Attorney for the District of Minnesota, Andrew Luger, spoke at a public event on March 3, 2016, at Mitchell-Hamline School of Law on the topic of health care fraud & abuse enforcement priorities in Minnesota. Luger began the discussion explaining the resource shortage issue in the white collar …
Finally, A Final Rule on ACA’s 60-Day Repayment Rule
February 12, 2016 Leave a Comment
On February 11, 2016, CMS released the much anticipated final rule on the so-called “60-day rule.” The long road to the final rule began when the Affordable Care Act (ACA) established the 60-day deadline for returning Medicare and Medicaid overpayments. The clock started running from the time an overpayment …