From HealthPayerIntelligence, Victoria Bailey: Cigna’s recent brush with False Claims Act violations serves as a reminder that Medicare Advantage organizations should be routinely assessing their risk and compliance activities. The United States alleged that Cigna submitted inaccurate and untruthful patient diagnosis data to receive additional payments from CMS and did not withdraw the inaccurate data […]
Author: WadeEmmert
From D Magazine, by Will Maddox: Drs. Desi and Deno Barroga were indicted for allegedly receiving $12 million from fraudulent claims and illegally distributing hydrocodone to patients from the Dallas pain management clinic where they operated. While at the clinic, the Barrogas would bill insurance for injections of anti-inflammatory steroids without administering the medicine. According […]
From Perkins Coie, by Stephanie Duchesneau, Susan Fahringer, Meredith Halama, Janis Kestenbaum: The legal landscape around health privacy has become much more complex in recent years, with more entities and types of data now subject to regulation and enforcement. The FTC has taken a broader view of what constitutes sensitive health data and has pursued […]
From Bloomberg Law, by Tony Pugh: The Biden administration finalized a rule requiring nursing homes to provide more detailed information about their ownership structure, including whether they are owned by private equity firms or real estate investment trusts (REITs). The additional data collected will be made public to allow families to make more informed choices […]
OIG released our General Compliance Program Guidance (GCPG). The GCPG is a reference guide for the health care compliance community and other health care stakeholders. The GCPG provides information about relevant Federal laws, compliance program infrastructure, OIG resources, and other items useful for understanding health care compliance. The GCPG is voluntary guidance that discusses general […]
From American Health Law Association, by Albert Lin, Husch Blackwell LLP, and Connor Campbell, Weaver and Tidwell LLP: This article reviews the rules surrounding the IRS principles of executive compensation with a focus on health care organizations and discusses best practices that the governing boards of such organizations should look for in exercising their fiduciary […]
From Health Law Diagnosis, by Nathaniel Arden & Michael Lisitano: On October 13, 2023, the Office of Inspector General (OIG) published Advisory Opinion 23-07, in which the OIG issued a favorable opinion regarding a physician group employer’s proposal to pay bonuses to its employed physicians based on net profits derived from certain procedures performed by […]
From Bloomberg Law, by Jacklyn Wille: “Cross-Plan Offsetting” is the practice by an insurer of clawing back benefits it says were overpaid to a provider under one plan by reducing future payments to the provider under a different plan that it administers. This common insurance billing tactic has invited litigation over its legality and opposition […]
From Bloomberg Law, by Madison Muller: Ozempic, and other GLP-1 receptor agonists, are diabetes medications that have become popular for weight loss. Now, there is evidence that they have other more far-reaching benefits too: They may have a protective effect on the heart, liver and kidneys. They may combat substance abuse or even Alzheimer’s disease. […]
From GibsonDunn, by Winston Chan, Jonathan Phillips, Gustav Eyler, John Partridge, Christopher Rosina, Carlo Felizardo, and Nicole Waddick: The FDA approval process for digital health “cyber devices” requires that premarket submissions contain cybersecurity information, including the company’s plans to address cybersecurity vulnerabilities, processes to provide a reasonable assurance that the devices are cybersecure, a software […]