Fraud & Abuse

No Fraud Waivers Contemplated On February 14, 2019, CMS’ Innovation Center announced its Emergency Triage, Treat, and Transport (ET3) Model for EMS / ambulance suppliers to partner with other health care providers such as telehealth entities and urgent care centers in order to triage and treat Medicare beneficiaries more effectively.  In response to a recent…… Continue reading this entry

Most busy scientific research laboratories have a spectrum of projects underway at any given time. Some projects are producing exciting results, and others seem to be heading nowhere. Why not shift personnel from the losers to the winners? Here’s one big reason: The government is watching. And unless you’re careful, simply moving a couple of…… Continue reading this entry

The alarming news about potential research misconduct can come in a variety of ways: a negative report in Retraction Watch, an anonymous “Clare Francis” letter, or a tip on the employee hotline. Regardless of the source, every institution must take each allegation seriously, especially if it involves research funded with federal dollars. Not only can a…… Continue reading this entry

The following article was originally published in May 2018 Compliance Today and is reprinted with permission. For years, misconduct in scientific research was policed primarily by the Office of Research Integrity (ORI) at the U.S. Department of Health and Human Services.1 After a lengthy and confidential review, an institution suspected of producing false or fraudulent…… Continue reading this entry

Health care providers are under constant threat of lawsuits brought by whistleblowers under the federal civil False Claims Act, 31 U.S.C. §§ 3729, et seq. (FCA), the statute under which the government obtains most judgements against providers. These qui tam lawsuits can be costly even where they lack any merit, and counsel for providers are…… Continue reading this entry

In a January 10, 2018 memo that leaked last week (the “Granston Memo”), the U.S. Department of Justice (DOJ) directs its prosecutors to more seriously consider dismissing meritless False Claims Act (FCA) cases brought by whistleblowers.  We have long argued DOJ dismissal is an underused tool provided by the FCA.  See “Dismissing FCA Cases Over…… Continue reading this entry

The Centers for Medicare and Medicaid Services (CMS) has demonstrated that it will not hesitate to use one of its most crippling administrative enforcement tools—the revocation of Medicare billing privileges—against one of its largest suppliers, as is evident in its case against Arriva Medical, LLC. Medicare billing privileges may be revoked for any one (or … Continue reading this entry