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New York Health Care Law Blog

AKS violations: A timeline of a typical case

Lawmakers designed the federal Anti-Kickback Statute (AKS) to help better ensure medical professionals focus on the well-being of their patients. Lawmakers intended this piece of regulation to reduce the risk of medical decisions based on financial gain. But what happens when the government accuses a medical company or individual of an AKS violation? The following discussion provides a basic timeline.

Step one: Awareness and charges

First, the government must become aware of a potential violation. This generally occurs either through a government investigation after noticing a discrepancy in Medicare or Medicaid claims or from a tip given by a whistleblower. If substantiated, the government may move forward with criminal charges.

If the government pursues criminal charges, authorities will notify the individual or business. At this time, it is wise to begin building a defense.

Lab owner sues hospital for breach of contract

Running a lab is a rewarding and difficult profession. In some cases, there are business considerations. Contracts may govern these arrangements. In a recent case, a lab owner accused a hospital of failing to fulfill its agreements as listed within the contract. The case involves a lab owner who went into contract with a large health care system to run a cancer research lab. The lab owner is well known within her field. Lynn Hlatky studied physics and biophysics, receiving a Ph.D. from the University of California, Berkeley. Harvard Medical School recruited the researcher and she joined faculty with the radiation and oncology department after developing a “model for cancer” using physics.

The evolution of the AKS to charge labs with health care fraud

The federal Anti-Kickback Statute (AKS) is a key piece of legislation used by the government to prosecute healthcare businesses and practitioners for fraud. The law is broad, and applies to services billed by physicians, nurses and even diagnostic labs.

How did the AKS expand to include labs?

Originally, lawmakers wrote the AKS to make the payment of kickbacks illegal. The definition of the term "kickbacks" led to some confusion. As a result, the government expanded the term kickbacks to include remuneration in 1982.

DOJ pursues first fraud charges for use of coronavirus funds

The United States Department of Justice (DOJ) recently announced criminal charges against two New England men. The agency claims the men were attempting to defraud the government’s recently unveiled small-business lending program — a program lawmakers intended to provide aid to small businesses struggling to survive during the current coronavirus pandemic.

FBI accuses youth football coach of health care fraud

A recent case provides an example of how the government moves forward with a case of health care fraud that may involve an unlikely offender and the types of penalties that can apply. According to the Federal Bureau of Investigation (FBI), the accused in this case was a youth football coach.

Ear, nose and throat specialists pay $9 mill to settle FCA claim

An ear, nose and throat (ENT) practice recently agreed to pay the government along with local state authorities over $9 million to settle claims they violated the federal False Claims Act (FCA) and state regulations.

The allegations involved an improper financial relationship. The government pursues such allegations fiercely, because it believes the relationship can result in compromising the physician’s medical judgment and endanger the public’s trust. It has various forms of punishment it can use if successful, including financial penalties and potential imprisonment.

3 ways the DOJ will use the FCA during the pandemic

The government has stated it is prepared to go after those who commit health care fraud to receive funds set aside to help deal with the coronavirus pandemic. True to its word, the Department of Justice (DOJ) has already reported one action against health care fraud related to the coronavirus. The agency states it moved forward with an action against a website offering a free vaccine against COVID-19 - patients need only pay the $4.95 shipping and handling fee. It has since ordered the website to shut down the offer.

NY Governor Cuomo announces win against opioid manufacturer

The governor of New York recently announced another legal tool it will use in its fight against the current opioid epidemic. According to Gov. Andrew Cuomo, the state’s Department of Financial Services (DFS) has filed an insurance fraud action against one of the major opioid manufacturers in the area.

NY telehealth company could get millions in acquisition deal

The current coronavirus pandemic has forced us to rethink our daily lives. We have had to change how we work, how we communicate, and how we get medical care.

One realization: we may have downplayed the importance of telemedicine. We have had the technology to utilize this platform for years but have yet to make the most of it. Now, in the midst of social distancing precautions, may be the opportunity for telemedicine to soar.

Retaliation or violation? Hospital fires nurse, nurse fights back.

A recent hospital firing of a nurse has shook up the health care community in Michigan. The hospital stated it fired the nurse due to inappropriate viewing of patient medical records. However, the nurse states this is not accurate. The termination came shortly after the nurse voiced concerns about the facility's ability to provide care during the current coronavirus pandemic. As a result, he argues the termination is illegal retaliation for speaking out against the hospital.

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