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McBrayer Blogs
Showing 3 posts tagged Healthcare fraud.
Pandemic Pivot to Telemedicine Creates New Compliance Issues for Healthcare Providers
The shift to telemedicine in the United States predates the pandemic, but COVID-19 has accelerated its widespread use. In April of 2019, the Centers of Medicare and Medicaid Service (CMS) finalized rules to increase telehealth benefits for Medicare Advantage enrollees, effectively incentivizing health systems with high numbers of private Medicare plan recipients to invest in telehealth services. More >
DOJ’s Nursing Home Initiative Targets Providers – Compliance Will Be Critical!
A new initiative announced by the Department of Justice (DOJ) on March 3, 2020, is aimed at investigating “grossly substandard care” in nursing homes. The National Nursing Home Initiative will initially be targeting the nation’s most problematic facilities and will use both civil and criminal enforcement actions where these facilities are putting the health and safety of residents in danger. The initiative serves as one focus in the DOJ’s larger efforts in protecting the elderly and is coordinated by the Elder Justice Initiative. More >
Good News, Providers: A Mere Difference of Medical Opinion Does Not A False Claim Make
FINALLY, some good news for providers related to false claims. In a very important Alabama case, a federal trial court granted summary judgment to AseraCare, Inc., in a False Claims Act[1] action where it had been alleged that the hospice program had knowingly submitted false claims to Medicare for patients who were allegedly not terminally ill. In its opinion, the U.S. District Court ruled that the Government may not prove falsity for purposes of the False Claims Act based solely upon the opinion of one medical expert who disagrees with the certifying physician and the patient's treating physicians about whether the medical records reported eligibility for the hospice benefit. In a ruling that all health providers can cheer, the court held that "[a] mere difference of opinion between physicians, without more, is not enough to show falsity."[2]
[1] 31 U.S.C. §§ 3729–3733
[2] United States v. AseraCare, lnc., No. 2:12-CV-245-KOB (MD
Alabama March 31, 2016) at 2. More >
