New York Health Care Law Blog

The law is always evolving. This is true whether discussing tax law, family law or the laws that impact health care. The tax code, for example, was the subject of the largest overhaul in recent history with the passage of the Tax Cuts and Jobs Act at the end of 2017.

This broad change to an area of law that is generally slow to evolve has led to questions about which laws could be next. Is it possible for such large reform within the laws that impact health care? The government has recently taken steps to indicate this could be possible.

The Department of Justice (DOJ) has petitioned the court to force provision of oral testimony deemed "relevant to a false claims law investigation." The government has accused a group that sponsors Medicare Part C insurance plans of "knowingly disregarding its duty to ensure the validity of data it submitted to Medicare for purposes of calculating" payments.

The government has sought testimony about three topics from corporate representatives to "expedite this investigation." The topics include questions about auditing procedures used to determine submitted diagnosis codes for four sample beneficiaries. Second, whether the polices, procedures and training regarding provider-submitted and chart review-generated diagnosis codes were valid and finally whether the personnel ensured compliance with these policies, procedures and training methods. The government questions whether the group investigated provider-submitted diagnosis codes unsupported by chart review results. It contends a failure to do so would support its allegations of a False Claims Act violation.

A data analytics firm has accused a healthcare provider of False Claims Act violations. The group states the provider illegally received payment for over $188 million in Medicare claims. If the suit is successful, the firm would receive a portion of the winnings.

The lawsuit is based on two primary allegations:

• Secondary codes. The lawsuit claims the provider increased its bill to Medicare by adding secondary codes to Medicare claims. The provider allegedly used these codes solely for the purpose of increasing the cost of the claim.
• Profitable diagnoses. The suit further contends the healthcare provider encouraged physicians to document diagnoses that would result in a high return. The provider allegedly gave medical professionals “tip sheets” to determine which secondary diagnoses were more financially profitable than others.

The United States Department of Justice (DOJ) has announced another regional Medicare Fraud Strike Force to join the current forces in 10 cities throughout the country. Strike Forces are currently present in Brooklyn, Miami, Los Angeles, Detroit, Houston, Baton Rouge, New Orleans, Tampa, Chicago and Dallas.

The new division will cover the Newark, NJ and Philadelphia, PA areas.