Articles and Blogs

Governor Scott Walker recently signed into law the HIPAA Harmonization – Mental Health Care Coordination Act (2013 WI Act 238, the “Act”).  The Act is intended to alleviate barriers to coordination of care for patients receiving mental health treatment by aligning aspects of Wisconsin’s mental health privacy laws with the Federal Health Insurance Portability and…Read More

Yesterday, the D.C. Circuit issued a much-anticipated decision regarding whether or not internal compliance investigations were privileged. Two recent lower court decisions had ruled that such compliance investigations were not privileged because they were for business rather than legal purposes. The D.C. Circuit disagreed and found that such compliance investigations are for legal purposes and…Read More

The Eighth Circuit affirmed that a Missouri regulatory commission’s publication of hearing testimony was “news media” sufficient to trigger the False Claims Act’s public disclosure bar. The False Claims Act includes a provision that bars FCA actions by qui tam relators if the subject matter of the action has been sufficiently disclosed by a federal…Read More

Comprehensive Post-Acute Care Reform Bill Introduced On June 26, leaders of the Senate Finance and House Ways and Means committees introduced comprehensive post-acute care legislation.  A summary of the legislation can be found here. According to a joint committee release, the legislation (H.R. 4994, S. 2553) would require data standardization to allow Medicare to compare quality…Read More

Executive Summary On June 25, 2014, the U.S. Department of Health and Human Services Office of the Inspector General (“OIG”) released a Special Fraud Alert (the “Alert”) addressing Laboratory Payments to Referring Physicians.  The Alert supplements previous guidance and is the latest in a series of advisories, dating back to 1994, discussing the fraud and…Read More

Yesterday, the American Hospital Association (“AHA”) submitted comments to CMS regarding the proposed FY 2015 inpatient prospective payment system (“PPS”) rule.  Topics addressed by AHA include:

Last week, the District Court of the Eastern District of Pennsylvania ruled that defendants in a False Claims Act case may bring a cause of action against the Relator for breach of a confidentiality agreement. Though such causes of action have been disfavored by other courts, this ruling paves a path for government contractors and…Read More

Executive Summary The Department of Health & Human Services Office of Inspector General (“OIG”) recently released a Supplemental Special Advisory Bulletin (“Supplemental Bulletin”) on the potential fraud and abuse implications of prescription drug patient assistance programs (“PAPs”).  The Bulletin updates OIG’s 2005 Special Advisory Bulletin (“2005 Bulletin”) on PAPs for Medicare Part D enrollees and…Read More

The Eleventh Circuit ruled last week that a conviction for criminal health care fraud against the owner of nursing home facilities was constitutional. The Court held that the government’s “worthless service” theory of fraudulent billing was not unconstitutional. In United States vs. George Houser, the government alleged that the defendant conspired to defraud the government…Read More

OCR Chief Regional Counsel for Region V, Jerome Meites, has warned that enforcement activity over the past year will “pale in comparison” to the next 12 months. While Mr. Meites was not specific as to this pronouncement being limited to Region V, it may be important to note that Region V covers Illinois, Indiana, Michigan,…Read More