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November 2018 Archives

3 lessons from NY medical center accused of healthcare fraud

It began with a remodel project. A hospital in Northern New York decided to update its site. The project included the addition of new patient suites and upgrades, scheduled for completion in 2019. The cost of the project soared from $466 million to $545 million. Funds were not the only thing that allegedly got out of control during the renovation. Whistleblowers also came forward stating hospital officials were taking kickbacks to gain millions in fraudulent payments.

Private equity deals with healthcare practices break records

The healthcare industry broke private equity activity records in 2017. Becker’s Hospital Review reports six big deals that were announced just this month. They include everything from a physical therapy practice management company to a healthcare software company.

Will midterm elections lead to regulatory change?

The results are in — Democrats gained at least 28 seats in the House of Representatives and have control of the chamber while the Republicans hold their majority in the Senate. This shift could impact a number of areas, including the push for regulatory relief in the healthcare industry.

Physicians and labs: New law increases risk of investigation

The “Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communications Act,” also known as the SUPPORT Act, is a broad piece of legislation signed into law by President Donald Trump on October 24, 2018. The law will impact healthcare in many ways. One example: it is now often illegal for physicians to get any form of compensation related to referring a patient to certain laboratories.

Escobar decision and implied certification in FCA cases

The False Claims Act (FCA) makes it illegal to use false or fraudulent claims to seek payment from government sources, like Medicare and Medicaid. This law is complex. Court cases have questioned the best way to apply the FCA to establish a violation. These cases often require the plaintiff establish four elements: "(1) a false statement or fraudulent course of conduct, (2) made with scienter, (3) that was material, causing (4) the government to pay out or forfeit moneys due." The outcome of these cases often hinges on the scienter and materiality elements.

Health care industry take note: Current enforcement trends

The health care industry is heavily regulated. Various laws and court cases impact the practices of drug manufacturers, physicians, nursing homes and others in the medical field. Those that are part of this field are wise to stay abreast of changes that could impact their profession.

Diagnostic labs victims of “aggressive audit tactics”

Audit activity by government regulators and private payers has been on the rise. These investigations ramped up throughout 2017 and accelerated through 2018. The dramatic increase in audits is likely connected to the price cuts implemented with the new Medicare Part B.

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