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Cutting Out the “Middleman”? HHS Resurrects Anti-Rebate Rule for Medicare Part D
[T]he Final Rule will modify the federal health care program’s Anti-Kickback Statute (“AKS”) safe harbors in three key ways: First, it will remove safe harbor protection…
Direct Contracting Model Comes to Medicare
Under the model, healthcare providers — which CMS calls “direct contracting entities,” or DCEs — will competitively bid to manage 100% of the Medicare Part A…
Jefferson County Doctor Convicted of Health Care Fraud Violations
The fraud and abuse laws can sometimes be obtuse, but this is a clear-cut case of intentional fraud. Grigoriy T. Rodonaia, of Port Neches, Texas, was…
OIG Issues Final Rules on Anti-Kickback Statute and the Civil Monetary Penalty
In its final rule, the OIG defined what constitutes “telehealth technologies” more broadly than in its proposed rule, but otherwise chose to track the conditions for…
Fifth Individual Charged in Health Care Kickback Conspiracy
The defendants are alleged to have conspired to pay and receive kickbacks in exchange for physicians’ orders that were used to submit claims for payment to…
Stark + AKS Final Rules
The final rules for changes to the Stark Law and Anti-Kickback Statute (healthcare fraud & abuse laws) have been published and go into effect on January…
OIG Fraud Concerns Over Physician Speaker Programs
In a Special Fraud Alert issued on November 16, 2020, the Department of Health and Human Services Office of Inspector General (HHS-OIG) raised significant fraud and…
Houston physician sentenced to prison for $17M billing fraud
Yolanda Hamilton, MD, was found guilty by a federal jury of participating in a Medicare scheme that involved signing false “plans of care” and other medical…
FTC sues to block $350 million sale of 2 Tenet Healthcare-owned hospitals in Memphis area
The Federal Trade Commission is suing to block Farmers Branch-based Tenet Healthcare’s $350 million sale of two hospitals in the Memphis area to another healthcare system.…
San Antonio ER hospital sued for alleged overbilling
A former patient has sued Baptist Emergency Hospital in San Antonio and its owner alleging they fraudulently overcharged for lab work to generate higher reimbursements. This…