Under the Federal Ethics in Patient Referrals Act (more commonly known as “Stark”), if a physician[1] has a financial relationship with an entity, the physician may not refer patients to the entity for medical services payable by Medicare unless the financial relationship complies with the Stark safe harbors. Thus, entities that lease or sublease
Fraud - Stark
OIG KO’s PODs: Physician Owned Distributorships
By Michael Cassidy on
Posted in Compliance, Fraud - Stark
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…
OIG Suspicious of Marketing Arrangements
By Michael Cassidy on
Posted in Fraud - Stark
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 Medical Center Signs Corporate Integrity Agreement
By Michael Cassidy on
Posted in Fraud - Stark
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…
Fifth Circuit Clarifies Qui Tam Public Disclosure Bar
By Michael Cassidy on
Posted in Fraud - Stark
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…
Ban on Physician Owned Hospitals Ruled Constitutional
By Michael Cassidy on
Posted in Fraud - Stark
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.
U.S. ex rel. Singh v. Bradford Regional Medical Center
By Michael Cassidy on
Posted in Fraud - Stark
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…
Most Wanted Healthcare Fugitives
By Michael Cassidy on
Posted in Fraud - Stark
The OIG is getting into the reality show venue. It is publishing a " Most Wanted List" for Healthcare fugitives. See below:
HHS OIG:A Roadmap for New Physicians Avoiding Medicare and Medicaid Fraud and Abuse
By Michael Cassidy on
Posted in Fraud - Stark
The U.S. Department of Health & Human Services, Office of the Inspector General, has published "A Roadmap for New Physicians Avoiding Medicare and Medicaid Fraud and Abuse." http://oig.hhs.gov/fraud/PhysicianEducation/
OIG Approves “Under Arrangements” Sleep Services
By Michael Cassidy on
Posted in Fraud - Stark
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…