New York Whistleblower Court First to Address What It Means to “Identify” Overpayment under ACA’s 60 Day Rule

Posted on January 21, 2015 by BSW

For the first time since its enactment as part of the Affordable Care Act (ACA) in 2010, a federal court in a whistleblower action will consider a provision requiring providers to return overpayments within sixty days of when they are “identified.” The upcoming decision by the United States District Court for the Southern District of New York in U.S. ex rel. Kane v. HealthFirst Inc. et al will likely be just the first of many decisions on the subject. Providers and government regulators are poised for what could prove a lengthy dispute at both the trial and appellate levels around the ACA’s 60 day rule and its interplay with overpayments in the False Claims Act (FCA) context. Continue reading →

OIG Issues Proposed Rule to Add New Safe Harbors and CMPs on Beneficiary Inducements and Gainsharing

Posted on October 2, 2014 by BSW

The Office of Inspector General (OIG) issued a Proposed Rule on October 2, 2014 that would amend the safe harbors to the Anti-Kickback Statute and the civil monetary penalty (CMP) rules to add new safe harbors to codify statutory changes in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and the Patient Protection and Affordable Care Act, that would protect certain payment practices and business arrangements from criminal prosecution or civil sanctions under the Anti-Kickback Statute. The OIG also proposed to codify certain revisions to the definition of “remuneration,” added by the Balanced Budget Act (BBA) of 1997 and ACA and add a gainsharing CMP provision in the OIG’s regulations. Continue reading →

Louisiana Health Insurance Exchange Roll-Out Includes Some Interesting Questions

Posted on September 25, 2013 by BSW

In November, 2012, Louisiana health officials declined to create a state-run exchange, leaving it to the federal government to operate a marketplace for Louisiana residents. Only recently has any real clarity on the structure of the Louisiana Health Insurance Exchange been available for its October 1, 2013 opening date. Continue reading →