With insight and analysis from expert attorneys who represent physicians and other healthcare professionals in all phases of their practice, the Physician Law Blog is the go-to source for physicians, nurses, chiropractors, dentists, physical therapists, and other allied health professionals interested in learning more about issues impacting their practices every day.

Happy HIPAA Times – Medical Center Settles with the OCR for Use Of Internet-Based Document Sharing

The OCR announced a settlement of $218,400 along with adoption of a robust plan of correction with St. Elizabeth’s Medical Center (SEMC) of Brighton, MA for alleged HIPAA violations. Before the settlement, SEMC had two different events leading up to it entering the resolution agreement with HHS. The first allegation involved a complaint to the…

New Risk for Hospitals – CMS Proposes Bundled Payments for Hip & Knee Replacement Surgeries

Building upon the bundled payment demonstration programs currently underway for Medicare, the Centers for Medicare and Medicaid Services (CMS) announced a proposal for a major shift in the way hospitals will be paid for hip and knee replacements. In an effort to incentivize hospitals to encourage quality and care improvements as patients transition from surgery…

Hot Day for HEAT – DOJ Settles FCA Lawsuit with PharMerica for $31.5M

Summer’s almost here and the weather is heating up for HEAT, the Department of Justice’s (DOJ) task force to combat healthcare fraud. This whistleblower initiated action was brought to the attention of the government by a former pharmacist employed by PharMerica. The settlement announced today relates to allegations of dispensing Schedule II controlled drugs without…

Learning the Hard Way – Omnicare to Pay $124M False Claims Settlement

False Claims Act (FCA) allegations are serious business. Anti-Kickback Statute prohibits offering, paying, soliciting or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid and other federally funded programs. Omnicare learned the hard way just how serious FCA actions can be when a whistleblower made allegations against it. The Department of…

ALERT – Clinical Labs under Scrutiny by OIG

As health care costs rise and providers are faced with challenges to meet the needs and demands of consumers; Medicare looks for questionable payments made to providers to ensure federal dollars for healthcare are spent for medically necessary services as it seeks to reduce fraud and abuse in the provision of health care. One such…

Fraud & Abuse Alert: OIG targets Excluded Employees

The OIG has demonstrated an increased focus on investigating employers to determine whether any employees are excluded from participating in Federal health care programs. When the OIG investigations reveal excluded employees, who allegedly provided items and services to Federal health care programs beneficiaries resulting in payments to the employers, the OIG has sought and obtained…

False Claims Act Update – 16 Hospitals to Pay $15.69M Related to Medically Unnecessary Psychotherapy Services

On May 7, 2015, the Department of Justice reported settlement with 16 separate hospitals for medically unnecessary or unreasonable psychotherapy services. The claims under scrutiny were Intensive Outpatient Psychotherapy (IOP) services, which represent a variety of treatment methods. The services, while billed to Medicare by the providers, were performed on the providers’ behalf by Allegiance…

DOJ sues HCR Manorcare for alleged Medically Unnecessary Therapy

Fraud and Abuse in healthcare remains a hot issue, as evidenced by recent HEAT announcements. Following three qui tam (whistleblower) actions being filed, the Department of Justice announced it would intervene in the consolidated lawsuits. At issue was whether HCR Manorcare exerted pressure on SNF administrators and rehabilitation therapists to provide medically unnecessary and unreasonable…

Hot Day for HEAT – Medicare Fraud Strike Force Announces 1 Conviction, 1 Guilty Plea & 1 Indictment Today

On April 17, 2015, the Health Care Fraud Prevention and Enforcement Action Team (HEAT) reported three new actions involving Medicare fraud and abuse. Since the Medicare Fraud Strike Force began in March 2007, HEAT has charged nearly 2,100 defendants who have collectively billed the Medicare program for more than $6.5B. The Medicare Fraud Strike Force,…

Happy HIPAA Thursday – Paper Records Count too!

Just ask Cornell Prescription Pharmacy about disposal of unshredded paper pharmacy records containing protected health information (PHI), and you will hear that this pharmacy paid $125,000 plus it has entered a Resolution Agreement with the OCR.  Not only is this pharmacy paying a significant penalty, it will be under a corrective action plan to correct…

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