CMS has issued the final regulations to implement that section of the Affordable Care Act amending the Social Security Act to provide that retention of identified overpayment could be a false claim and be subject to both the False Claims Act (FCA) and the Civil Money Penalty Act (CMP). ACA § 6402(a) established new Social … Continue Reading
Cooper v. Pottstown Hospital is another case where a dissatisfied party is attempting to use the federal Anti-Kickback Statute or the Stark Law in litigation arising out of the contracts to which they were willing parties at one time. Usually, breaching parties have used this argument as a defense, claiming that the contracts were illegal, … Continue Reading
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 Act … Continue Reading
Section 6409 of the Patient Protection and Affordable Care Act (PPACA) required CMS to develop a Medicare Self-Referral Disclosure Protocol (SRDP) to facilitate the resolution of potential Stark violations. The SRDP was published on September 23, 2010 with two caveats: 1. Despite the fact that potential violations or situations might violate more than just the Stark … Continue Reading
The United States District in Kosenske v. Carlisle HMA Inc. has concluded that this whistleblower case must go to trial on the factual issue of whether Carlisle Hospital violated the False Claims Act by submitting claims for anesthesia services provided arising from referrals from Blue Mountain Anesthesia Associates (BMAA). Dr. Kosenske, the whistleblower in this case, … Continue Reading
The U.S. Department of Justice issued a press release on August 25, 2009 announcing a $4.5 million False Claims Act Settlement against an Iowa hospital, Covenant Medical Center. The False Claims Act liability allegations were based upon charges by the Attorney General that paying excessive compensation violated the Stark Law. Based upon IRS 990 forms, the … Continue Reading
President Obama signed the Fraud Enforcement and Recovery Act of 2009 on May 28, 2009, which is the effective date of the Act. I am attaching a compared version identifying all the changes, but I would like to direct your attention to what I believe is the most significant change impacting typical healthcare providers. Retentions … Continue Reading
