$1,000,000 Fine Imposed for Incorrect In-network Information

In a letter from the Centers for Medicare & Medicaid Services (“CMS”) Medicare Parts C and D Oversight and Enforcement Group issued on April 2, 2015, CMS imposed a civil money penalty of $1,000,000 on health insurer, Aetna, Inc. The $1,000,000 fine was based on Aetna’s “failure to disseminate clear and accurate information regarding the number, mix, and distribution (addresses) of network pharmacies from which enrollees may obtain covered Part D drugs,” which CMS found violated obligations imposed by  42 C.F.R. § 423.128(a)(2) and 42 C.F.R. § 423.509(a)(2). Continue reading

Can Healthcare Provider Employers Pay Employees Bonuses Under the AKS?

A $20M lawsuit filed in Florida against the AIDS Healthcare Foundation raises questions about whether healthcare employers can bonus their employees for generating business (marketing) under the anti-kickback statute.  Several whistleblower employees claim that the company inappropriately incentivized/bonused employees for patient referrals.  Employees were allegedly paid $100 for referring patients who tested positive to the company’s clinics and pharmacies.  The company asserts that not only has it done nothing wrong, but that its pro-active approach is critical to stopping HIV in this country.  The government has not intervened in the suit.  See the Associated Press article available HERE for more details.

Link: http://hosted.ap.org/dynamic/stories/U/US_HIV_MEDICARE_SCAM?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT&CTIME=2015-04-09-01-42-46

Written by: Emily Grey

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Does a Hospital Have a Brady Obligation to Turn Over Exculpatory Evidence?

A recent decision by the United States Court of Appeals for the Tenth Circuit answered whether hospitals under state contract have Brady obligations. Established by the Supreme Court decision of Brady v. Maryland, a Brady obligation imposes on government agents the duty to turn over exculpatory evidence to a requesting criminal defendant.  373 U.S. 83, 83 S. Ct. 1194 (1963). In Tiscareno v. Frasier, the Tenth Circuit held that a hospital did not have an actionable Brady obligation because there was no clearly established constitutional obligation of the hospital to locate and disclose the exculpatory evidence to the criminal defendant. No. 13-4156, 2015 WL 735668, at *1 (10th Cir. Feb. 23, 2015). Continue reading