The OIG has issued a Special Fraud Alert, dated March 26, 2013, describing specific attributes and practices of Physician Owned Distributorships (PODs) believed to produce substantial fraud and abuse risk and pose dangers to patient safety.
PODs are physician owned entities that derive revenue from selling or arranging for the sale of implantable medical…
In OIG Advisory Opinion No. 11-17, the OIG has broadcast its suspicion of percentage based marketing arrangements.
The request seeks the OIG’s “no action” letter on a proposal by which a company will provide consulting and marketing services to physician practices. The services would be designed to review patients’ files and identify opportunities to provide allergy…
Ohio Valley Health Services & Education Corporation, Ohio Valley Medical Center and East Ohio Regional Hospital have collectively entered into a corporate Integrity Agreement with the OIG in September 2011, which focuses on what are defined as “focus arrangements,” which is defined as every financial arrangement between the hospital system and physicians covered by the…
The Qui Tam process is designed to encourage and Whistleblowers or “relaters” to disclose illegal billing arrangements by paying a percentage of any recovery to the relaters for providing “confidential” information. The theory is that these individuals will be providing information with would not otherwise become available. A corollary to this theory is that relaters cannot…
In Physician Hospitals of America v. Sebelius, the U.S. District Court for the Eastern District of Texas upheld § 6001 of the Patient Protection and Affordable Care Act of 2010 (PPACA), which prohibits new physician owned hospitals and the expansion of those already existing.
The USDC for the Western District of Pennsylvania has issued a significant False Claims Act Whistleblower Opinion in the case of U.S. ex rel. Singh v. Bradford Regional Medical Center. The False Claims Act case rested on a lease arrangement between certain physicians and Bradford Regional Medical Center, which the court ruled violated the Stark…
The OIG is getting into the reality show venue. It is publishing a " Most Wanted List" for Healthcare fugitives. See below:
In OIG Advisory Opinion No. 10-24, a sleep testing entity with no physician ownership proposes to provide sleep disorder diagnostic testing and related services to a hospital as “under arrangements” contract, in which the hospital would bill for the services as a hospital outpatient service. The Requester would provide the sleep testing equipment, the sleep…
The 2011 Medicare Physician Fee Schedule adds an additional requirement to the in-office ancillary services exception of the Stark Rules. New Section 411.355(b)(7) requires that providers of MRI, CT and PET services must provide a written notice to the patient at the time of the referral, advising that the patient may receive the same services from…
