OIG Enforcement Initiatives Relating to Hospitals. Outline of Presentation
|
|
- Preston Wilson
- 5 years ago
- Views:
Transcription
1 OIG Enforcement Initiatives Relating to Hospitals S. Craig Holden Ober Kaler 1 Lew Morris Adelman Scheff & Smith,LLP Outline of Presentation 2013 OIG Work Plan Issues for Hospitals Trends in Individual Liability Recent Cases of Note Recent Advisory Opinions of Note New OIG Tools Suspension of payment Mandatory Compliance Programs 60 Day Repayment Voluntary Disclosure 2 1
2 OIG Work Plan for 2013 Selected Hospital Audit Initiatives New Initiatives Inpatient Medicare billing DRGs possible 14 day window Hospital owned physician practices billing providerbased Transfer policy compliance Payments for canceled surgeries Payments for mechanical ventilation Discharges to swing beds in other hospitals QIOs 3 OIG Work Plan for 2013 Selected Hospital Audit Initiatives Continuing initiatives of note Same day readmissions Accuracy of present on admission indicators Medicare inpatient and outpatient payments to acute care hospitals Acute care hospital inpatient transfers to inpatienthospice care Trends in outlier payments 4 2
3 OIG Work Plan for 2013 Legal/Investigative Initiatives Compliance with Corporate Integrity Agreements (CIA s) Review of entities who settle cases without a CIA Compliance training 5 Ripped from the Headlines Fourteen Hospitals to Pay U.S. More Than $12 Million to Resolve False Claims Act Allegations Related to Kyphoplasty (Feb., 2012) Hospital Chain HCA Inc. Pays $16.5 Million to Settle False Claims Act Allegations Regarding Chattanooga, Tenn., Hospital (Sept., 2012) Missouri Hospital System Agrees to Pay $9.3 Million to Resolve False Claims Act and Stark Law Violations (Nov., 2012) WakeMed enters into $8 million settlement to resolve investigation concerning outpatient hospital visits billed to Medicare as inpatient hospital stays (Dec., 2012) 6 3
4 OIG Organization Inspector General Principal Deputy Inspector General Office of Audit Services Office of Evaluations and Inspections Office of Management and Policy Office of Investigations Office of Counsel
5 EXCLUSION UNILATERAL MONITORING CORPORATE INTEGRITY AGREEMENT LOW PRIORITY RELEASE - SELF-DISCLOSURE 9 9 OIG Exclusion Authorities Key authorities: 42 USC 1320a 7(a) Mandatory exclusions (a)(1) Conviction of program related offense (a)(2) Conviction of patient abuse (a)(3) Felony conviction of health care fraud Permissive exclusions (b)(7) Fraud or kickbacks (b)(15)(i) Individuals with an ownership or control interest in a convicted or excluded entity (b)(15)(ii) Officers or managing employees of a convicted or excluded entity 10 5
6 Trends in Individual Liability DOJ criminal actions Recent pharmaceutical manufacturer cases under the Park doctrine Synthes/Norian 10/10 corporate plea to felony off label marketing/improper clinical trials.» $23.5 million settlement amount» Divestiture required» CIA Four executives plead to Park misdemeanors» Jail sentences in each case 11 Trends in Individual Liability Stryker Biotech, LLC. Settlement 1/30/12 Corporate misdemeanor plea with $15 million fine Charges dropped against CEO and other individual employees WellCare indictments Company settled for $137.5 million in April, 2012 Indictment of five former executives of Medicaid HMO, including former CEO,CFO and GC Awaiting trial Unsuccessful indictment and prosecution of GSK in house counsel 12 6
7 Recent Individual Exclusion Actions Purdue Executives Court upheld OIG discretionary exclusions of executives who had pled to Park misdemeanors Convictions met statutory test of related to fraud Lack of intent irrelevant 12 year period struck as arbitrary and capricious Friedman v. Sebelius, 686 F3d 813 (DC Cir. 2012) KV Pharmaceuticals CEO (Hermelin) excluded under (b)(15) after Park plea by company 13 Will exclude OIG Guidance re Exclusions Owners if knew or should have known of conduct Officer or managing employees ( operational or managerial control or directs day to day operations) No statutory knowledge requirement Will only go after those who knew or should have known Rebuttable presumption that this standard is met 14 7
8 OIG Guidance re Exclusion Circumstances of the misconduct and seriousness of the offense Nature of sanction Amount of harm How pervasive Individual s role Position Individual s actions Compliance efforts Cooperation/disclosure Size/record of entity 15 WakeMed Recent Cases of Note Allegations of fraudulent billing of one day stays in cases where observation was ordered Tentative deferred prosecution agreement requiring an $8 million payment WakeMed prohibited from making disparaging remarks regarding the prosecutors case Judge rejected agreement Current status unclear 16 8
9 Recent Advisory Opinions of Note Advisory Opinion OIG approves a hospital s provision of an electronic interface to ordering physicians Could be used to order lab and other diagnostic test Hospital would provide maintenance and software updates Physicians responsible for EHR and hardware OIG concludes Integrally related to hospital s services No independent value 17 Recent Advisory Opinions of Note Advisory Opinion OIG approves hospital/physician co management arrangement that includes performance bonuses at the hospital, cardiac catheterization labs Requestor is a rural hospital in a medically underserved area Operates 4 cath labs Only cath labs in a 50 mile radius 18 9
10 Recent Advisory Opinions of Note AO continued Co management agreement with local 18 member cardiology group General cardiologists Interventional cardiologists 6 of whom do cath procedures Electrophysiologists Only group in the area performing cath procedures 19 Recent Advisory Opinions of Note AO continued Co management terms Fixed annual fee Performance fee up to amount of fixed fee Performance criteria (over a set baseline) Employee satisfaction (5%) Patient satisfaction (5%) National survey data Start times Reduced time between cases 20 10
11 Recent Advisory Opinions of Note AO continued Quality measures (30%) Based on national cardiology measures» Door to balloon time» Prescription of beta blockers» Various others Cost savings (60%) Based on percentage reduction of cost per case» Single vendor purchasing of stents» Certain items limited to an as needed basis» Various others 21 Recent Advisory Opinions of Note AO continued Safeguards Cost savings measures developed based on evidence and clinical outcomes External valuation of FMV of both fees Independent third party review of performance fee factors and clinical outcomes 22 11
12 Recent Advisory Opinions of Note AO continued Physician commit to not: Stint on care Increase referrals to the hospital Cherry pick patients for procedures at the cath labs Accelerate patient discharges Physicians agree that, to the extent that the payments result in practice group dividends, they will be distributed pro rata to the group members, including those who do not refer. 23 Recent Advisory Opinions of Note AO continued CMP analysis Fixed fee, patient satisfaction, employee satisfaction and quality components do not implicate the CMP Cost saving component does implicate the CMP by creating and incentive to reduce or limit services 24 12
13 Recent Advisory Opinions of Note AO continued CMP analysis Safeguards sufficient to protect beneficiaries Certification that no adverse effect on patient care, with continued monitoring Doctor free to use any product they deem medically appropriate No patient specific standards Incentives limited in scope and duration Physician commitments 25 Recent Advisory Opinions of Note AO continued Kickback analysis Implicates the statute Approves based on: FMV certification Compensation does not vary with referrals No other cath labs in the area Specificity of measure makes clear that they are designed to reward quality Limited duration 26 13
14 Recent Advisory Opinions of Note AO continued Remaining questions Same result if not the only players in the market? How can a pro rata distribution of revenue by the group work in practice? No cherry picking Really? Another way of saying you have to refer your good patients? 27 Recent Advisory Opinions of Note AO OIG refuses to bless two anesthesia arrangements with safe harbored physician owned ASCs Arrangement A Exclusive arrangement with anesthesia provider Provider pays per patient fee (private pay patients only) for management services Pre op nursing assessments Space for provider s physicians and records Transfer of billing information 28 14
15 Recent Advisory Opinions of Note OIG analysis of Arrangement A Carve out of government patients ineffective since arrangement is exclusive as to all patients The cost of the services under the arrangement are already included in the facility fee paid to the ASC by Medicare and other payers Double payment creates a clear kickback risk 29 Recent Advisory Opinions of Note Arrangement B ASC would establish a wholly owned subsidiary for the sole purpose of providing anesthesia to the ASC s patients Sub would contract with provider to provide all administrative functions relating to anesthesia for a set fee paid out of anesthesia receipts Anesthesia personnel would either be employed by the sub on be engaged as independent contractors 30 15
16 Recent Advisory Opinions of Note OIG analysis of Arrangement B Because sub is not an ASC, the ASC safe harbor does not apply, thus flow of dividends up to ASC and then to physician owners not protected, Arrangements with provider and anesthesia personnel could be protected by either the employment or personal services safe harbor Analogizes arrangement to the Contractual Joint Venture Special Advisory Alert Permits physician owners to do indirectly what they cannot do directly 31 Recent Advisory Opinions of Note Critique of OIG analysis ASC safe harbor clearly does permit physician owners to do this directly Medicare ASCs expressly permitted to purchase anesthesia services and bill for them directly with safe harbor protection MLN Matters MM6358 Fact that a wholly owned sub was chosen makes no substantive difference 32 16
17 New Tools: Payment Suspension 6402(h) of PPACA First statutory authority for payment suspensions. CMS may suspend payments to a Medicare provider or supplier pending an investigation of a credible allegation of fraud. States must suspend payments to Medicaid provider or supplier, unless the State determines there is good cause not to suspend such payments. CMS Regulation February Mandatory Compliance Programs 6401 of PPACA makes compliance programs mandatory......but only after implementing regulations establish the core elements for mandatory compliance programs Growing numbers of providers are establishing (or updating) compliance programs in anticipation of them becoming mandatory
18 60 Day Repayment Requirement 6402 of PPACA requires reporting and repayment of overpayments within 60 days of identification (or due date of next cost report, if applicable) What s identification? Violations actionable under FCA Regulatory guidance expected soon
19 37 37 Breakdown of CMS Settlements 38 19
Anti-Kickback, Stark, And False Claims Act Liability
Anti-Kickback, Stark, And False Claims Act Liability Sean R. McKenna U.S. Attorney s Office for the Northern District of Texas Assistant U.S. Attorney 1100 Commerce Street, 3 rd Floor Dallas, TX 75242-1699
More informationA DISCUSSION WITH THE OIG
1 A DISCUSSION WITH THE OIG MICHAEL J ARMSTRONG REGIONAL INSPECTOR GENERAL FOR AUDIT SERVICES STEPHEN J CONWAY DIRECTOR, ADVANCED AUDIT TECHNIQUES ROBERT K DECONTI CHIEF, ADMINISTRATIVE & CIVIL REMEDIES
More informationAHLA. F. Anti-Kickback Primer. David E. Matyas Epstein Becker & Green PC Washington, DC
AHLA F. Anti-Kickback Primer David E. Matyas Epstein Becker & Green PC Washington, DC Martha J. Talley Chief, Industry Guidance Branch Office of the Inspector General US Department of Health and Human
More informationFederal Administrative Sanctions
FEDERAL AND STATE ADMINISTRATIVE SANCTIONS HCCA COMPLIANCE INSTITUTE April 23, 2007 Chicago, IL Edgar D. Bueno Pillsbury Winthrop Shaw Pittman LLP John W. O Brien Office of Counsel to the Inspector General
More informationBeware Excluded Individuals and Entities
Beware Excluded Individuals and Entities Publication 7/30/2014 Kim Stanger Partner 208.383.3913 Boise kcstanger@hollandhart.com Federal laws generally prohibit providers from billing for services ordered
More informationCo-Management Arrangements and Their Continuing Evolution Trends Issues Fair Market Value
Co-Management Arrangements and Their Continuing Evolution Trends Issues Fair Market Value Presented by: Gregory D. Anderson, CPA/ABV, CVA HORNE LLP 601.268.1040 greg.anderson@horne-llp.com Ann S. Brandt,
More informationPrepared with the Assistance of Jacob Harper, Law Clerk, Morgan Lewis. HHS OIG Exclusion Overview 1
AHLA Institute on Medicare and Medicaid Payment Issues Exclusions and Administrative Sanctions March 20 & 21, 2013 Howard J. Young Partner, Morgan, Lewis & Bockius, LLP Prepared with the Assistance of
More informationFederal Fraud and Abuse Enforcement in the ASC Space
Federal Fraud and Abuse Enforcement in the ASC Space SCOTT R. GRUBMAN, ESQ. PARTNER CHILIVIS COCHRAN LARKINS & BEVER, LLP (ATLANTA GA) Fraud & Abuse Enforcement Landscape FBI CMS OCR MFCU DCIS DOJ HHS-OIG
More informationMANAGING HOSPITAL/PHYSICIAN FINANCIAL RELATIONSHIPS
MANAGING HOSPITAL/PHYSICIAN FINANCIAL RELATIONSHIPS James D. Horwitz, Esq. HCCA Annual Compliance Institute April 27, 2009 AGENDA Laws and Environment Application of laws, agency actions and guidance to
More information2013 Health Care Regulatory Update. January 8, 2013
2013 Health Care Regulatory Update January 8, 2013 Fraud and Abuse: A Year in Review Jeff Fitzgerald Settlement Trends Pharma/Device Pharma settlements continue Abbott paid $1.5B (off-label, sales conduct)
More informationSharmin Rahman, BS Consultant, Compliance. Senior Manager, Compliance. Objectives. We the People - Government Authority
Exclusion Checks: Who? What? When? Where? How? Sharmin Rahman, BS Consultant, Compliance Karen Voiles,MBA,CHC, CHPC, CHRC Senior Manager, Compliance Objectives We the People - Government Authority Legislative
More informationAND THE NEED TO UNDERTAKE
COMPLIANCE CHALLENGE: UNDERSTANDING FEDERAL AND STATE EXCLUSION/DEBARMENT ACTIONS, THEIR IMPLICATIONS, AND THE NEED TO UNDERTAKE REGULAR SANCTION SCREENING Overview Risks associated with exclusions Federal
More informationThis course is designed to provide Part B providers with an overview of the Medicare Fraud and Abuse program including:
This course is designed to provide Part B providers with an overview of the Medicare Fraud and Abuse program including: Medicare Trust Fund Defining Fraud & Abuse Examples of Fraud & Abuse Fraud & Abuse
More informationThe Anesthesia Company Model: Frequently Asked Questions
The Anesthesia Company Model: Frequently Asked Questions 1. What is the situation in Florida? Florida-specific Issues For several years, FSA members have been contacting the society with reports of company
More informationChapter 13 Section 6. Provider Exclusions, Suspensions, And Terminations
Program Integrity Chapter 13 Section 6 1.0 SCOPE AND PURPOSE 1.1 This section specifies which individuals and entities may, or in some cases must, be excluded from the TRICARE program. It outlines the
More informationCriteria for implementing section 1128(b)(7) exclusion authority April 18, 2016
Criteria for implementing section 1128(b)(7) exclusion authority April 18, 2016 Preamble Under section 1128(b)(7) of the Social Security Act (the Act), the Office of Inspector General (OIG) of the U.S.
More informationTelemedicine Fraud and Abuse Under the Microscope
Telemedicine Fraud and Abuse Under the Microscope Session 232, February 14, 2019 Douglas Grimm, Esq., Arent Fox LLP Hillary Stemple, Esq., Arent Fox LLP 1 Conflicts of Interest Douglas Grimm, Esq. Has
More informationSANCTION SCREENING: OIG HIGH RISK PRIORITY
SANCTION SCREENING: OIG HIGH RISK PRIORITY Overview Healthcare organizations and entities have as a Condition of Participation the affirmative duty to screen all those with whom they have a business relationship
More informationTop 10 Issues in APM Contract Negotiations
Legal Issues in New Contracting and Risk Sharing Models - What To Know Before You Sign Alexis Finkelberg Bortniker Foley & Lardner LLP 617-226-3177 Abortniker@foley.com June 2, 2017 Top 10 Issues in APM
More informationStark/Anti- Kickback Fundamentals
Stark/Anti- Kickback Fundamentals HEALTHCON Business Expo April 2016 Presented by: Stacy Harper, JD, MHSA, CPC 1 Disclaimer This presentation is for general education purposes only. The information contained
More informationSTRIDE sm (HMO) MEDICARE ADVANTAGE Fraud, Waste and Abuse
Fraud, Waste and Abuse Detecting and preventing fraud, waste and abuse Harvard Pilgrim is committed to detecting, mitigating and preventing fraud, waste and abuse. Providers are also responsible for exercising
More informationCertifying Employee Training Navicent Health s Corporate Integrity Agreement Year Two
Certifying Employee Training Navicent Health s Corporate Integrity Agreement Year Two Corporate Integrity Agreement Effective 4/23/2015 Term of five years Basic Requirement: Maintain a Compliance Program
More informationLaw Department Policy No. L-8. Title:
I. SCOPE: Title: Page: 1 of 13 This policy applies to (1) Tenet Healthcare Corporation and its wholly-owned subsidiaries and affiliates (each, an Affiliate ); (2) any other entity or organization in which
More informationOFFICE OF INSPECTOR GENERAL WORK PLAN FISCAL YEAR 2006 MEDICARE HOSPITALS
OFFICE OF INSPECTOR GENERAL WORK PLAN FISCAL YEAR 2006 MEDICARE HOSPITALS GABRIEL L. IMPERATO, Esq. Broad & Cassel Fort Lauderdale, Fl. Medicare Hospitals Areas of Focus for OIG Work Plan 2006 Adjustments
More informationStark and the Anti Kickback Statute. Regulating Referral Relationship. February 27-28, HCCA Board Audit Committee Compliance Conference.
Stark and the Anti Kickback Statute Ryan Meade, JD, CHRC, CHC F Director, Regulatory Compliance Studies Beazley Institute for Health Law and Policy Loyola University Chicago School of Law rmeade@luc.edu
More informationHospital Incentive Payments to Physicians for Quality and Cost Savings
Hospital Incentive Payments to Physicians for Quality and Cost Savings Implications under the Fraud and Abuse Laws March 1, 2011 Dennis S. Diaz Davis Wright Tremaine LLP dennisdiaz@dwt.com 213-633-6876
More informationAnti-Kickback Statute and False Claims Act Enforcement
Anti-Kickback Statute and False Claims Act Enforcement Nicholas Gachassin, III, Esq. Gachassin Law Firm, LLC Nick3@gachassin.com Press Conference on Health Care Fraud and the Affordable Care Act May 13,
More informationIt s Here: The Final 60 Day Overpayment Rule
It s Here: The Final 60 Day Overpayment Rule (What it means for you and your clients) Hillary M. Stemple, Esq. Associate Arent Fox LLP Washington, DC 20006 hillary.stemple@arentfox.com December 5, 2017
More information7/25/2018. Government Enforcement in the Clinical Laboratory Space. The Statutes & Regulations. The Stark Law. The Stark Law.
Government Enforcement in the Clinical Laboratory Space 2 SCOTT R. GRUBMAN, ESQ. The Statutes & Regulations 3 4 AKA the physician self-referral law The Rule: If physician (or immediate family member) has
More informationLegal Issues: Fraud and Abuse Navigating Stark and Kickback. Reece Hirsch, Esq. Jordana Schwartz, Esq. HIT Summit West March 7, 2005
Legal Issues: Fraud and Abuse Navigating Stark and Kickback Reece Hirsch, Esq. Jordana Schwartz, Esq. HIT Summit West March 7, 2005 The Counterintuitive Industry Business arrangements that make perfect
More informationWhat is the HHS OIG?
An Update on Government Enforcement Actions from the OIG HCCA - Southwest Regional Annual Conference February 21, 2014 Karen Glassman, Senior Counsel Office of Counsel to the Inspector General What is
More informationHealth Care Contracting
Health Care Contracting Best Practices Toolkit and Three Tenets of Defensibility Presented by Presented at The Alaska State Hospital and Nursing Home Association Annual Conference September 27, 2017 Barbra
More informationAmerican Academy of Orthopaedic Surgeons 2010 Annual Meeting. March 12, 2010
American Academy of Orthopaedic Surgeons 2010 Annual Meeting March 12, 2010 Developments in the Evolving Orthopaedic Surgeon - Industry Relationship Kathleen McDermott, Esquire Washington, DC 1 Developments
More informationHCCA Compliance Institute Dallas, Texas Session 401- Monday, April 19, 2010
Take a Second Look at Your Physician Relationships: Tips Based on Experience and Changes in the Law HCCA Compliance Institute Dallas, Texas Session 401- Monday, April 19, 2010 Jana Kolarik Anderson, Attorney
More informationStark, AKS, FCA Primer
Stark, AKS, FCA Primer December 1, 2016 Christine Savage (csavage@choate.com, 617-248-4084) by any measure CHOATE HALL & STEWART LLP choate.com Physician Self-Referral Prohibition (the Stark Law ): History
More informationHandling Potential Overpayment and "Voluntary" Refund Situations
Handling Potential Overpayment and "Voluntary" Refund Situations Timothy P. Blanchard, MHA, JD American Academy of Professional Coders 2011 National Conference April 4, 2011 2011 Blanchard Manning LLP.
More informationWHAT EVERY NEW PRACTITIONER SHOULD CONSIDER
WHAT EVERY NEW PRACTITIONER SHOULD CONSIDER January 24, 2017 Andrew N. Meyercord Gray Reed & McGraw 1601 Elm Street Suite 4600 Dallas, Texas 75201 214.954.4135 ameyercord@grayreed.com 129 attorneys Full-service,
More informationDEPARTMENT OF HEALTH AND HUMAN SERVICES. Office of Inspector General s Use of Agreements to Protect the Integrity of Federal Health Care Programs
United States Government Accountability Office Report to Congressional Requesters April 2018 DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of Inspector General s Use of Agreements to Protect the Integrity
More informationStark Self-Disclosure. Thomas S. Crane 1/ Mintz Levin Cohn Ferris Glovsky and Popeo, PC
Stark Self-Disclosure Thomas S. Crane 1/ Mintz Levin Cohn Ferris Glovsky and Popeo, PC A. Background 1. Stark Law The Physician Self-Referral Statute (or the Stark Law ) prohibits a physician from referring
More informationPhysician Relationship Compliance Issues
Physician Relationship Compliance Issues Charles Oppenheim Hooper, Lundy & Bookman, PC Overview of Anti-Kickback Statute It is a federal crime to: Knowingly and willfully offer or pay/solicit or receive
More informationPhysician Relationship Compliance Issues. Charles Oppenheim Hooper, Lundy & Bookman, PC
Physician Relationship Compliance Issues Charles Oppenheim Hooper, Lundy & Bookman, PC Overview of Anti-Kickback Statute It is a federal crime to: Knowingly and willfully offer or pay/solicit or receive
More informationFraud and Abuse Primer Hypotheticals
Fraud and Abuse Primer Hypotheticals Sanford V. Teplitzky S.Craig Holden William T. Mathias Ober Kaler Baltimore, Maryland PHYSICIAN RECRUITMENT HYPO Hospital A is located in a rapidly growing community
More informationOffice of Inspector General. Regional Enforcement Efforts and Priorities in Florida. South Atlantic Regional Conference January 28, 2011
Office of Inspector General Regional Enforcement Efforts and Priorities in Florida Health Care Compliance Association South Atlantic Regional Conference January 28, 2011 Felicia Heimer, Esq. Office of
More informationAgenda. Strategic Considerations in Resolving Voluntary Government Disclosures
Strategic Considerations in Resolving Voluntary Government Disclosures Health Care Compliance Association Annual Compliance Institute Patrick Garcia Hall, Render, Killian, Heath, & Lyman, P.C. Kenneth
More information2/24/2017. Agenda. Determine Potential Liability. Strategic Considerations in Resolving Voluntary Government Disclosures. Relevant legal authorities:
Strategic Considerations in Resolving Voluntary Government Disclosures Health Care Compliance Association Annual Compliance Institute Patrick Garcia Hall, Render, Killian, Heath, & Lyman, P.C. Kenneth
More informationH e a l t h C a r e Compliance Adviser
March 2001 Volume 5 Number 1 H e a l t h C a r e Compliance Adviser OIG Issues New Advisory Opinion on Gainsharing Reversing July 1999 Special Advisory Bulletin In a welcome departure from its former position,
More informationAnti-Kickback Statute Jess Smith
Anti-Kickback Statute Jess Smith Overview 1972 - Enacted 1977 - Violation became a felony 1996 - Expanded to include all Federal Health Care Programs 2009 - Health Care Fraud Prevention and Enforcement
More informationRidgecrest Regional Hospital Compliance Manual
Printed copies are for reference only. Please refer to the electronic copy for the latest version. REVIEWED DATE: 06/02/2014 REVISED DATE: 07/02/2013 EFFECTIVE DATE: 10/17/2007 DOCUMENT OWNER: APPROVER(S):
More informationMedicare Parts C & D Fraud, Waste, and Abuse Training
Medicare Parts C & D Fraud, Waste, and Abuse Training IMPORTANT NOTE All persons who provide health or administrative services to Medicare enrollees must satisfy FWA training requirements. This module
More informationApril 27, Dear Mr. Levinson:
Mr. Daniel Levinson, Inspector General Office of the Inspector General U.S. Department of Health and Human Services 300 Independence Avenue, S.W. Washington, DC 20201 Dear Mr. Levinson: We are writing
More informationImproving Integrity in Nursing Centers
Improving Integrity in Nursing Centers Susan Edwards Reed Smith LLP AHCA/NCAL s General Counsel Goals of this webinar Introduce you to AHCA/NCAL s Fraud and Abuse Toolkit Provide you with a basic understanding
More informationHOSPITAL COMPLIANCE POTENTIAL IMPLICATION OF FRAUD AND ABUSE LAWS AND REGULATIONS FOR HOSPITALS
HOSPITAL COMPLIANCE H C C A R E G I O N A L C O N F E R E N C E A P R I L 2 8, 2 0 1 6 S A N J U A N, P U E R T O R I C O S A N C H E Z B E T A N C E S, S I F R E & M U Ñ O Z N O Y A, C S P J A I M E S
More informationU.S. v. Sulzbach: Government Theories, Potential Defenses, and Lessons Learned
U.S. v. Sulzbach: Government Theories, Potential Defenses, and Lessons Learned Presented By: David O Brien Christine Rinn Michael Paddock HOOPS 2007 - Washington, DC October 15-16 Background June 1994:
More informationCaught between Scylla and Charibdis: Regulatory Parameters for Designing P4P and Gainsharing Programs
Caught between Scylla and Charibdis: Regulatory Parameters for Designing P4P and Gainsharing Programs Bruce J. Toppin, Esq. Vice President and General Counsel North Mississippi Health Services Daniel F.
More informationThere is nothing wrong with change, if it is in the right direction Winston Churchil
Changes Changes 2012 2012 There is nothing wrong with change, if it is in the right direction Winston Churchill New tools provided by the Affordable Care Act are strengthening the Obama administration
More informationPanelists: During US latest fiscal year FY2011 (October 2010-September 2011)
What s New With Exclusions? Medicare/Medicaid Program March 28-30, 2012 Baltimore, Maryland Panelists: Jaishiri Mehta Administrative and Civil Remedies Branch Office of Counsel to the HHS Inspector General
More informationFraud and Abuse Compliance for the Health IT Industry
Fraud and Abuse Compliance for the Health IT Industry Session 89, March 6, 2018 James A. Cannatti III, Senior Counselor for Health Information Technology, U.S. Department of Health and Human Services (HHS),
More informationAHLA. DD. Hot Topics in Laboratory Compliance. Karen Stephanie Lovitch Mintz Levin Cohn Ferris Glovsky & Popeo PC Washington, DC
AHLA DD. Hot Topics in Laboratory Compliance Karen Stephanie Lovitch Mintz Levin Cohn Ferris Glovsky & Popeo PC Washington, DC Robert J. Rossi Senior Vice President & Chief Compliance Officer Calloway
More informationFAST BREAK: GOVERNMENT ENFORCEMENT OF INDIVIDUAL ACCOUNTABILITY. Katie McDermott Jacob Harper February 28, Morgan, Lewis & Bockius LLP
FAST BREAK: 2015 Morgan, Lewis & Bockius LLP GOVERNMENT ENFORCEMENT OF INDIVIDUAL ACCOUNTABILITY Katie McDermott Jacob Harper February 28, 2017 2015 Morgan, Lewis & Bockius LLP Discussion Agenda Individual
More informationGOALS OF THIS PRESENTATION HOW WE GOT HERE WHERE WE ARE MANDATORY COMPLIANCE REQUIREMENTS LESSONS FROM MANDATORY COMPLIANCE IN NEW YORK MY PREDICTIONS
MANDATORY COMPLIANCE: WHAT THE FUTURE LOOKS LIKE HCCA SOUTH ATLANTIC REGIONAL MEETING 1/28/11 JAMES G. SHEEHAN NEW YORK MEDICAID INSPECTOR GENERAL James.Sheehan@Omig.NY.gov GOALS OF THIS PRESENTATION HOW
More informationManaging Financial Interests: The Anti Kickback Statute (AKS)
Managing Financial Interests: The Anti Kickback Statute (AKS) Board of Commissioners Meeting February 15, 2012 Presented by: Mic Sager, Compliance Officer Context: Business Transactions o Health Care is
More informationIndustry Funding of Continuing Medical Education
Industry Funding of Continuing Medical Education June 25, 2010 Julie K. Taitsman, M.D., J.D. Chief Medical Officer, Office of Inspector General U.S. Department of Health and Human Services Financial Relationships
More information2014 Lathrop & Gage LLP Lathrop & Gage LLP Lathrop & Gage LLP
Legal Issues for Physician Owned Implant Manufacturer/Distribution Companies (PODs) October 24, 2014 Randal L. Schultz, Esq. 10851 Mastin Blvd, Building 82, Suite 1000 Overland Park, KS 66210-1669 913.451.5192
More informationSelf-Disclosure: Why, When, Where and How
American Bar Association Washington Health Law Summit Self-Disclosure: Why, When, Where and How December 8, 2015 Margaret Hutchinson U.S. Attorney s Office for the Eastern District of Pennsylvania Kaitlyn
More informationAPPROACHES FOR HOSPITALS CONFRONTING STARK AND ANTI-KICKBACK ISSUES
APPROACHES FOR HOSPITALS CONFRONTING STARK AND ANTI-KICKBACK ISSUES CORRECTIVE ACTION, PHYSICIAN NEGOTIATION, AND VOLUNTARY DISCLOSURE; CASE STUDIES Dennis Diaz Partner Davis Wright Tremaine LLP Jim Watson
More informationFundamentals of Healthcare Valuation for Health Lawyers and Compliance Officers
Fundamentals of Healthcare Valuation for Health Lawyers and Compliance Officers Theresa Carnegie, Esq. Albert Chip Hutzler, JD, MBA, CVA AHLA/HCCA Fraud and Compliance Forum September 30, 2013 1 Agenda:
More informationFALSE CLAIMS ACT ENFORCEMENT: RECENT TRENDS AND STEPS TO ENSURE COMPLIANCE AND AVOID FRAUD ALLEGATIONS
FALSE CLAIMS ACT ENFORCEMENT: RECENT TRENDS AND STEPS TO ENSURE COMPLIANCE AND AVOID FRAUD ALLEGATIONS The Carolinas Center s 39 th Annual Hospice & Palliative Care Conference Columbia, SC Presenters:
More informationGainsharing Structure and Related Legal Issues
Gainsharing Structure and Related Legal Issues By: David Glaser Adam Romney 612.492.7143 206.757.8238 dglaser@fredlaw.com adamromney@dwt.com June 27, 2017 2 3 Gainsharing/Shared Savings/Co- Management/Alignment
More informationCBI PAP LEGAL UPDATE MEDICARE & MEDICAID A REVIEW OF COMPLIANCE WITH GOVERNMENT PROGRAMS. September 26, Sarah difrancesca Partner Cooley LLP
CBI PAP LEGAL UPDATE MEDICARE & MEDICAID A REVIEW OF COMPLIANCE WITH GOVERNMENT PROGRAMS September 26, 2017 Sarah difrancesca Partner Cooley LLP attorney advertisement Copyright Cooley LLP, 3175 Hanover
More informationFor over a decade, the Office of Inspector General
SANCTIONS RICHARD P. KUSSEROW Clarifying Sanction Screening: OIG LEIE and Entities versus GSA EPLS Do Organizations Need to Have the Same Diligence for Both Lists? Richard P. Kusserow, is the former Health
More informationCompliance in Physician Employment and Hospital- Physician Integration
Compliance in Physician Employment and Hospital- Physician Integration Winn W. Halverhout Husch Blackwell LLP Barbara A. Yosses Poudre Valley Health System Husch Blackwell LLP 1 Current Integration Structures
More informationS ark L aw aw An A t n i-kickbac b k S atut u e an an d Fal F se Cl C aims A c A t E f n orcement Jay y P. P A n A sti t n i e, e JD R adma m p
Stark Law, Anti-kickback Statute and False Claims Act Enforcement Jay P. Anstine, JD HCCA Physician Practice Compliance Conference Philadelphia, PA October 17-19, 19, 2010 1 Roadmap Fraud and Abuse laws
More informationContents of Presentation:
Office of the Attorney General Medicaid Fraud and Abuse Control Division Michael E. Brooks, Executive Director Medicaid Fraud and Abuse Control Division Office of the Attorney General mike.brooks@ag.ky.gov
More informationNavigating Self-Disclosure
Navigating Self-Disclosure Charlie Fletcher, CHC Chief Compliance Officer MAURY REGIONAL MEDICAL CENTER Matthew M. Curley BASS BERRY & SIMS PLC John N. Joseph POST & SCHELL, P.C. Self-Disclosure: Legal
More informationWhat s On Tap? Who Are the Players? 4/3/2017. Healthcare Enforcement Trends What To Do When the Government Comes Knocking?
Healthcare Enforcement Trends What To Do When the Government Comes Knocking? Holly Logan Craig Sieverding 1 What s On Tap? Enforcement landscape, generally Fraud and Abuse Update o Brief primer on major
More informationCORPORATE INTEGRITY AGREEMENT BETWEEN THE OFFICE OF INSPECTOR GENERAL OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES AND TEXAS GENERAL SURGEONS
I. PREAMBLE CORPORATE INTEGRITY AGREEMENT BETWEEN THE OFFICE OF INSPECTOR GENERAL OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES AND TEXAS GENERAL SURGEONS hereby enters into this Corporate Integrity Agreement
More informationFRAUD, WASTE, & ABUSE (FWA) for Brokers. revised 10/17
FRAUD, WASTE, & ABUSE (FWA) for Brokers revised 10/17 OBJECTIVES After reviewing this information, you will be able to: Understand Fraud, Waste, and Abuse (FWA) training requirements; Be familiar with
More informationAHLA. U. Physician Relationship Audit Workshop: A Practical Guide to Auditing Physician Relationships and Addressing Identified Issues
AHLA U. Physician Relationship Audit Workshop: A Practical Guide to Auditing Physician Relationships and Addressing Identified Issues Bret S. Bissey Senior Vice President, Compliance Services MediTract,
More informationGAINSHARING & PAY FOR PERFORMANCE -- P4P UPDATE ON RECENT DEVELOPMENTS AND INITIATIVES
GAINSHARING & PAY FOR PERFORMANCE -- P4P UPDATE ON RECENT DEVELOPMENTS AND INITIATIVES presented by Robert D. Girard, Esq. Davis Wright Tremaine LLP A. Gain-Sharing B. Provider P4P programs C. Government
More informationWHAT YOUR BOARD NEEDS TO KNOW ABOUT COMPLIANCE NATIONAL MEDICARE RAC SUMMIT 9/13/10
WHAT YOUR BOARD NEEDS TO KNOW ABOUT COMPLIANCE NATIONAL MEDICARE RAC SUMMIT 9/13/10 JAMES G. SHEEHAN NEW YORK MEDICAID INSPECTOR GENERAL James.Sheehan@OMIG.NY.GOV 518 473-3782 3782 1 RAC, MIC, DATA MINING
More informationCoding Partners in Patient Safety
Coding Partners in Patient Safety Senior Loss Prevention Attorney UF Self Insurance Programs Learning Objectives Understand federal fraud and abuse laws and the importance of coders in avoiding issues.
More informationD E B R A S C H U C H E R T, C O M P L I A N C E O F F I C E R
D E B R A S C H U C H E R T, C O M P L I A N C E O F F I C E R INTEGRATED CARE ALLIANCE, LLC CORPORATE COMPLIANCE PROGRAM It is the policy of Integrated Care Alliance to comply with all laws governing
More informationSpecial Advisory Bulletin
Special Advisory Bulletin The Effect of Exclusion From Participation in Federal Health Care Programs September 1999 A. Introduction The Office of Inspector General (OIG) was established in the U.S. Department
More informationGETTING SERIOUS ABOUT MEDICAID COMPLIANCE:SECTION 6402 OF PPACA AND THE DUTY OF DISCLOSURE OF IDENTIFIED OVERPAYMENTS 7/14/10
GETTING SERIOUS ABOUT MEDICAID COMPLIANCE:SECTION 6402 OF PPACA AND THE DUTY OF DISCLOSURE OF IDENTIFIED OVERPAYMENTS 7/14/10 JAMES G. SHEEHAN NEW YORK MEDICAID INSPECTOR GENERAL James.Sheehan@OMIG.NY.GOV
More informationFundamentals and Practicalities of Identifying and Returning Overpayments
Fundamentals and Practicalities of Identifying and Returning Overpayments American Health Lawyers Association Physicians and Physician Organizations Law Institute Hospitals and Health Systems Law Institute
More informationEffective Date: 9/09
North Shore-LIJ Health System is now Northwell Health POLICY TITLE: Screening of Federal and State Exclusion Lists POLICY #: 800.05 System Approval Date: 7/21/16 Site Implementation Date: Prepared by:
More informationCMS Opens its Doors by Creating the Stark Voluntary Self-Referral Disclosure Protocol But Enter at Your Own Risk
A BNA s HEALTH LAW REPORTER! Reproduced with permission from BNA s Health Law Reporter, hlr, 10/07/2010. Copyright 2010 by The Bureau of National Affairs, Inc. (800-372-1033) http:// www.bna.com CMS Opens
More informationDrive Defensively: How Hospice Officers and Directors Can Avoid Liability CHAPCA 2013 Annual Conference October 28-30, 2013
Drive Defensively: How Hospice Officers and Directors Can Avoid Liability CHAPCA 2013 Annual Conference October 28-30, 2013 Diane M. Racicot, Esq. Procopio, Cory, Hargreaves & Savitch, LLP 525 B Street,
More informationPHYSICIAN PRACTICES IN A STARK WORLD. David E. Matyas. A. The Statutory Prohibition (Social Security Act 1877; 42 U.S.C. 1395nn)
PHYSICIAN PRACTICES IN A STARK WORLD David E. Matyas I. OVERVIEW OF THE STARK LAW A. The Statutory Prohibition (Social Security Act 1877; 42 U.S.C. 1395nn) The federal physician self-referral statute prohibits
More informationMedical Ethics. Paul W. Kim, JD, MPH O B E R K A L E R
Medical Ethics Paul W. Kim, JD, MPH O B E R K A L E R 410-347-7344 pwkim@ober.com 1 Agenda Federal Fraud & Abuse Laws Federal Privacy Laws Enrollment Audits Post-Payment Audits Pre-Payment Reviews 2 False
More informationPHYSICIAN INVESTMENT COMPLIANCE
PHYSICIAN INVESTMENT COMPLIANCE Dr. NICK OBERHEIDEN LYNETTE BYRD 1-800-810-0259 Available on Weekends page 1 INTRODUCTION Many physicians are tempted to develop income from ancillary services. While there
More informationGainsharing Is it Still Feasible? May 14, 2010
7 th Annual Illinois Chapter ACC Practice Management Symposium Gainsharing Is it Still Feasible? May 14, 2010 W. Kenneth Davis, Jr. Partner Katten Muchin Rosenman LLP 525 W. Monroe Chicago, Illinois 312.902.5573
More informationSCHEMES, SCAMS AND FLIM-FLAMS: HOW THE DME SUPPLIER CAN RECOGNIZE FRAUD LANDMINES. Denise Leard, Esq Brown & Fortunato, P.C.
SCHEMES, SCAMS AND FLIM-FLAMS: HOW THE DME SUPPLIER CAN RECOGNIZE FRAUD LANDMINES Denise Leard, Esq. 2017 Brown & Fortunato, P.C. INTRODUCTION 2 INTRODUCTION When Medicare first came into existence, there
More informationMEETING THE SANCTION SCREENING CHALLENGE: RULES, REQUIREMENTS, AND METHODS.
MEETING THE SANCTION SCREENING CHALLENGE: RULES, REQUIREMENTS, AND METHODS. Richard P. Kusserow, former DHHS IG Jillian Bower, MPA OVERVIEW OF PROGRAM Why sanction screening is a must Credentialing vs.
More informationAnti-Kickback Statute: Are Per-Patient Referral Fee Arrangements Permissible?
REFERRAL COMPENSATION GREGORY S. SAIK.IN/NATHANIEL C. KUMMERFELD* Anti-Kickback Statute: Are Per-Patient Referral Fee Arrangements Permissible? Federal Judge's Decision in United States v. Crinel Allows
More informationIn this course, we will cover the following topics: The structure and purpose of Navicent Health s Compliance Program The requirements of the
In this course, we will cover the following topics: The structure and purpose of Navicent Health s Compliance Program The requirements of the Navicent Health s Corporate Integrity Agreement (CIA) Your
More informationStaying Compliant: A Roadmap to Self-Disclosure
12/18/2015 Staying Compliant: A Roadmap to Self-Disclosure By Linda A. Baumann and Hillary Stemple, Arent Fox LLP The new requirements for overpayment return, along with increasing enforcement, are making
More informationRecent Developments In Voluntary Disclosure Stark Law
HCCA Compliance Institute 2010 Legal & Regulatory W6, Part1 April 21, 2010 Recent Developments In Voluntary Disclosure Stark Law Jeffrey Fitzgerald Faegre & Benson LLP jfitgerald@faegre.com 303.607.3740
More informationRecent and Emerging Issues Related to Clinical Laboratory Testing and How to Avoid Them. Compliance
Recent and Emerging Issues Related to Clinical Laboratory Testing and How to Avoid Them Robert E. Mazer, Esquire Baker Donelson Bearman Caldwell & Berkowitz, PC rmazer@bakerdonelson.com (410) 862-1159
More informationMedicare Overpayment 60 Day Rule
Medicare Overpayment 60 Day Rule What Your Compliance and Auditing Departments Need to Know Objectives Review the key legal, operational and technical takeaways from the ACA 60 Day Report and Repay Statute.
More information