New OIG Fraud Alert Out on June 9, 2015 Cautions That Physician Compensation Arrangements May Result in Significant Liability

Posted on June 15, 2015 by BSW

“Physicians who enter into compensation arrangements such as medical directorships must ensure that those arrangements reflect fair market value for bona fide services the physicians actually provide. Although many compensation arrangements are legitimate, a compensation arrangement may violate the anti-kickback statute if even one purpose of the arrangement is to compensate a physician for his or her past or future referrals of Federal health care program business.”

http://oig.hhs.gov/compliance/alerts/guidance/Fraud_Alert_Physician_Compensation_06092015.pdf

Written by: Traci Thompson

Clay J. Countryman and Alec Alexander to Present at 2015 Physicians Legal Issues Conference

Posted on June 5, 2015 by BSW

Clay J. Countryman and Alec Alexander, partners in the firm’s Healthcare Group will give presentations at the Physicians Legal Issues Conference to be held June 10-12, 2015 at the Palmer House Hilton in Chicago, IL. The Physicians Legal Issues Conference is co-sponsored by the American Bar Association Health Law Section, Chicago Medical Society and the American Association for Physician Leadership®. Mr. Countryman is Co-Chair of the conference and he will present as part of a panel on a session titled, “Community Clinics and Pharmacies: Opportunities for Physicians and Attorneys to Work Together” on June 11. Mr. Alexander will be presenting on a panel for a session titled “Navigating the Perilous Waters of the False Claims Act From Medical Necessity to the Anti-Kickback Statute and Beyond” on June 11.

Alec Alexander Clay Countryman

Criminal Cyberattacks Against Health Care Providers Are On the Rise

Posted on May 8, 2015 by BSW

A recent study by Ponemon Institute, the Fifth Annual Benchmark Study on Privacy and Security of Healthcare Data, concluded that the majority of data breaches are not accidental, but intentional. These cyberattacks against health care providers cost the U.S. health care system $6 billion a year. According to the report, the average cost of a data breach for healthcare organizations is more than $2.1 million, and the average cost of a data breach for business associates is more than $1 million. Continue reading →

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

Posted on April 16, 2015 by BSW

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?

Posted on April 9, 2015 by BSW

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