On August 5, 2016, the United States Attorney for the Middle District of Georgia announced a civil settlement in which Sweet Dreams Anesthesia, a partnership of certified registered nurse anesthetists (CRNAs), paid over $1,015,000 to resolve allegations that Sweet Dreams paid kickbacks to ambulatory surgery centers to induce Medicare and Medicaid patients by providing free anesthesia drugs and through other financial transactions. Continue reading
Author Archives: Breazeale Sachse
South Carolina Hospital to Pay $17 Million to Resolve False Claims Act and Stark Law Allegations
On July 28, 2016, the U.S. Department of Justice announced, “The Lexington County Health Services District Inc. d/b/a Lexington Medical Center located in West Columbia, South Carolina, has agreed to pay $17 million to resolve allegations that it violated the Physician Self-Referral Law (the Stark Law) and the False Claims Act by maintaining improper financial arrangements with 28 physicians.”
According to the government press release, “The United States alleged that Lexington Medical Center entered into asset purchase agreements for the acquisition of physician practices or employment agreements with 28 physicians that violated the Stark Law because they took into account the volume or value of physician referrals, were not commercially reasonable or provided compensation in excess of fair market value.
Also as part of the settlement, Lexington Medical Center will enter into a Corporate Integrity Agreement (CIA) with the Department of Health and Human Services-Office of the Inspector General (HHS-OIG) that requires Lexington Medical Center to implement measures designed to avoid or promptly detect future conduct similar to that which gave rise to this settlement.
Written by: Clay J. Countryman
OIG Corporate Integrity Agreements and Physician Compliance Programs
In settling allegations of violating the False Claims Act (FCA), healthcare providers often enter into a Corporate Integrity Agreement with the OIG in exchange for the OIG’s agreement not to exclude the provider from participation in Medicare or other federal health care programs. Corporate Integrity Agreements (CIAs) generally require a provider to establish or supplement an existing compliance program, with detailed requirements described in the CIA. Continue reading
Plans Offered by Insurers on Louisiana’s ACA Exchange Hiking Rates by Double-Digits
Nearly 211,000 Louisiana residents covered under an “Obamacare” plan can expect to see rate hikes between 16.4 and 30.75 percent in 2017. The premium hikes are meant to cover the massive losses the plans have accumulated. Insurer’s filings with the Louisiana Insurance Department detail enrollee’s increased use of services, higher costs of benefits and prescription drugs and lower payments from a federal program meant to protect insurers from unexpectedly high claims and losses. Among the plans proposing increases are Blue Cross and Blue Shield of Louisiana, Aetna Health Inc., Humana Health Benefit Plan of Louisiana Inc., and Vantage Health Plan Inc. In April, UnitedHealth pulled itself from the ACA Exchanges in Louisiana and most other states after it says their plans in those states accumulated losses of more than $1.1 billion nationally over a two-year period. UnitedHealth’s departure from Louisiana’s ACA Exchange will leave approximately 29,000 people looking for a new insurer for 2017.
Louisiana Governor Signs Legislation Banning Common Abortion Procedure
On June 1, 2016, Gov. John Bel Edwards signed a bill into law that bans the second-trimester abortion procedure known as “dilation and evacuation.” This makes Louisiana the sixth state to prohibit this abortion method. Under the new law, called the “Unborn Child Protection from Dismemberment Abortion Act,” the procedure will only be allowed if necessary to prevent “serious health risk” to the mother. The law takes effect on August 1, 2016. Only the performing physician will be legally responsible and subject to penalties for violations of the ban. The penalties could include loss of license to practice medicine and the possibility of a fine up to $1,000 and a prison sentence of up to two years.
It is unclear whether this law will stand up to a legal challenge. A similar law was blocked by state courts in Kansas and Oklahoma as violating the state Bill of Rights and the Due Process Clause of the Fourteenth Amendment of the U.S. Constitution.
See full text of the Unborn Child Protection from Dismemberment Abortion Act here.
Written by: Catherine Moore
bswhealthlaw.com 