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McBrayer Blogs
Showing 15 posts in False Claims Act.
CMS Rule on Medicare Overpayments? Don’t Hold Your Breath
Since the Center for Medicare & Medicaid Services proposed a rule three years ago suggesting that providers could be liable for returning Medicare overpayments going back ten years, providers have been anxiously awaiting a final ruling. Unfortunately, providers’ anticipation for a final ruling will have to continue. On February 16th, CMS announced that it would delay the final rule on reporting and returning overpayment…by another full year! More >
The DOJ Increases Scrutiny of Whistleblower False Claims Act Suits
The Criminal Division of the Department of Justice (“DOJ”) recently announced that it will review all complaints filed under the qui tam provisions of the federal False Claims Act (“FCA”) to determine if a parallel criminal investigation is appropriate. This announcement came during a September 17, 2014 speech by the recently-confirmed Assistant Attorney General for the Criminal Division of the DOJ, Leslie Caldwell, at the Taxpayers Against Fraud Education Fund Conference in Washington D.C. This DOJ announcement signals a departure from prior policy, which allowed, but did not require, the Criminal Division to investigate Civil Division claims. In the past, the decision to open a criminal investigation was left to the discretion of each U.S. Attorney’s Office. More >
Sound Inpatient’s Unsound Practices Lead to $14.5 Million Settlement
On July 3, 2013, the United States Department of Justice announced Sound Inpatient Physicians, Inc. (“Sound Inpatient”) will pay $14.5 million dollars to settle allegations that it over-billed Medicare and other federal health care programs. The Washington-based company employs more than 700 hospitalists and post-acute physicians to facilities in twenty-two states. More >
CMS Has Issued Proposed Rule Which Would Force Providers to Report Overpayments in 60 Days
The Centers for Medicare & Medicaid Services (“CMS”) released proposed regulations on Tuesday, February 14, 2012 proposing that providers and suppliers must report any self-identified overpayments within 60 days of the incorrect payment being identified or on the date when a corresponding cost report is due, whichever is the latter. More >
The Doctor’s Doctor: Professional Courtesy in an Age of Healthcare Regulation
For over 200 years, professional courtesy has been a hallmark of physician practice, a symbol of collegiality among doctors. Historians describe its 18th century beginnings as physicians providing charity care for the families of their deceased colleagues—an early form of health insurance for doctors’ widows and children. Over the years, the concept of collegial care also became the preferred alternative to physicians treating themselves or their own family members. In fact, the American Medical Association’s (“AMA”) first code of medical ethics created an obligation among doctors to reciprocate medical care and to extend the courtesy to physician family members as well. Today, the AMA recognizes professional courtesy as a “long-standing tradition” but not an ethical requirement.[1] The federal government’s commentary about “the provision of free or discounted health care items or services to a physician or his or her immediate family members or office staff,” however, is far more cautious than nostalgic. [2] The Department of Health and Human Services Office of Inspector General’s advice that physicians “consult with an attorney” before extending professional courtesy warns that certain arrangements for free or discounted medical care run afoul of fraud and abuse laws.[3] More >
