A Broader Definition of “Referral” for Anti-Kickback Violations

Posted on March 20, 2015 by Breazeale Sachse

In U.S. v. Patel, whether a violation of the Anti-Kickback Statute was present depended on the United States Court of Appeals for the Seventh Circuit’s interpretation of the term “referring,” a term not specifically defined in the statute. 2015 WL 527549 (7th Cir. 2/10/15). The Seventh Circuit considered whether Dr. Kamal Patel had “referred” patients to a home health care provider in violation of the Anti-Kickback statute when Dr. Patel signed Form 485 certifications and recertifications for his patients, though did not recommend a specific home health care provider, in exchange for cash. Continue reading →

Medical Malpractice Liability for Management Companies

Posted on March 10, 2015 by Breazeale Sachse

When can a company that manages a hospital be liable for the medical malpractice of the institution and its physicians? According to one recent New Mexico decision, when its agents knew of pattern of sub-standard conduct and didn’t act to address it. The case involved one physician performing experimental surgery on over 100 patients over a period of years. The decision allowing the claim against the manager was rendered in the hospital’s bankruptcy proceeding, which it filed in an attempt to survive the patients’ claims. Review this article on Insurance News Net for a more complete discussion.

Written by: Greg Frost

Hospital Liability for Employee HIPAA Breaches

Posted on February 13, 2015 by Breazeale Sachse

A hospital employee, who has been “HIPAA-trained” and admits to knowing better, accesses his ex-wife’s new boyfriend’s medical records and posts sensitive information on social media. Is the hospital liable for the employee’s actions?

First, assume that the hospital did nothing wrong. That requires the assumption that the employee was adequately trained, that the employee’s job required that he have access to this data, and that there was no way to otherwise limit the employee’s access. Continue reading →

OIG Making Widespread Review of Questionable Billing Practices for Pediatric Dental Services – Louisiana Included

Posted on February 6, 2015 by Breazeale Sachse

The Office of Inspector General of the United States Department of Health and Human Services is reviewing questionable billing practices related to Medicaid billing for pediatric dental services throughout Louisiana. A description of this state and national initiative can be found here. Continue reading →

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 Breazeale Sachse

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 →