Articles and Blogs

House Ways and Means Committee Advances Medicare Program Integrity Bill On Thursday, February 26, the House Ways and Means Committee approved four bills, including a broad Medicare anti-fraud bill and a measure that would require hospitals to notify patients when they are considered to be under observation status.  The anti-fraud bill (H.R. 1021) was introduced…Read More

Today the Sixth Circuit Court of Appeals joined several other Circuit Courts in finding that an administrative review, and even a repayment to the appropriate government oversight entity, did not qualify as a “public disclosure” under the False Claims Act’s public disclosure bar.

The Department of Health and Human Services Office of Inspector General (“OIG”) recently issued Advisory Opinion 15-01,1 which provided a favorable opinion of an arrangement that offered Medicaid beneficiaries free diapers and playpens if the beneficiaries chose a provider’s program for the state’s Maternal Infant Health Program (“Arrangement”). OIG found that the Arrangement did not…Read More

Executive Summary On November 20, 2014, President Obama announced the Immigration Accountability Executive Action, a series of steps directed toward reforming the United States immigration system.   As part of these initiatives, United States Citizenship and Immigration Services (“USCIS”) Director León Rodríguez announced yesterday that the Department of Homeland Security (“DHS”) is extending eligibility for employment…Read More

On February 23, 2015, the U.S. Department of Labor announced a rule change to be issued February 25, 2015 that ensures that all eligible employees in same-sex marriages will enjoy the same rights and protections under the Family Medical Leave Act (“FMLA”) as employees in opposite-sex marriages.

A clearly irate Fifth Circuit Court of Appeals reversed summary judgment granted on behalf of Shell Exploration and Development Company, for the second time, and remanded with an order that the case be assigned to a new judge. In United States ex rel. Little v. Shell Exploration the Fifth Circuit, for the second time, reversed the trial court’s…Read More

A recent case out of the Northern District of Illinois Federal Court, US ex rel. Oughatiyan v. IPC the Hospitalist Company, Inc., demonstrates the high risk inherent in evaluation and management (E&M) coding for health care providers.

Executive Summary In response to the 2012 meningitis outbreak traced to tainted injections compounded by the New England Compounding Center, OIG recently published a study entitled “Medicare’s Oversight of Compounded Pharmaceuticals Used in Hospitals: OEI-1-13-0040” (“Study”).  OIG made the following findings: State survey agencies and accreditation agencies (e.g., The Joint Commission, HFAP, DNV, Center for…Read More

This month’s announcement of the recent Anthem Data Breach sent shockwaves through the health care industry with some experts referring to 2015 as the “year of the health care hack.” Those who collect and store health data have been racing to strengthen security protocols and to understand their risk exposure. In a first-of-its-kind case in the…Read More

CMS Delays Final Rule on Collecting Medicare Overpayments On Tuesday, February 17, CMS announced through the Federal Register that it will postpone until February 16, 2016 the implementation of a proposed rule that would require Medicare providers under Parts A and B of Title XVIII to return overpayments within 60 days. CMS first proposed the rule, which includes…Read More