On March 10, 2022, the Department of Justice (“DOJ”) appointed a Director for COVID-19 Fraud Enforcement.[1] As a part of this announcement, DOJ announced some of its priorities in Health Care Fraud enforcement. The priorities focus on kickbacks, utilizing the relaxed rules to bill for medically unnecessary or never performed services, vaccine-related fraud, and fraud …
NEW EKRA INTERPRETATION PROVIDES SOME GUIDANCE IN ITS APPLICATION
On October 24, 2018, the Eliminating Kickbacks in Recovery Act (“EKRA”) was enacted. Broadly speaking, EKRA prohibits soliciting, receiving, paying, or offering “any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind,” for referring or to induce a referral to a recovery home, clinical treatment facility, …
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Anti-Kickback Statute and Stark Law Recent Updates
Those serving in the health care industry are all too familiar with the Anti-Kickback Statute and the Stark Law – physician self-referral and fraud and abuse laws that prohibit financial payments or incentives for referring patients, specifically a Medicare or Medicaid patient. In December 2020, The Officer of Inspector General (OIG) Final Rule and the …
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Loaded Questions: Are Noncompetition and Nonsolicitation Clauses Really Enforceable in Michigan?
As an employment lawyer, there are a number of questions I frequently hear from clients and colleagues. One of the most common ones is, “I thought noncompetes weren’t really enforceable. Is that true?” This question takes many forms. For example: Employer Client: “I don’t want to prevent someone from working, so I just have my …
HHS Announces the COVID-19 Vaccine Coverage Assistance Fund
On May 3, 2021, the U.S. Department of Health & Human Services (“HHS”) announced the creation of the COVID-19 Coverage Assistance Fund (“CAF”).[i] Providers who administered the vaccine to patients on or after December 14, 2020, can now seek reimbursement for certain amounts they were unable to bill to patients for administering the vaccine. For …
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The Regulatory Sprint to Value-Based Care
On December 2, 2020, the CMS and the OIG published the rules modifying the safe harbors under the Anti-Kickback Statute[1] and exceptions under the Stark Law[2]. This article presents an overview of the value-based rules, which became effective on January 19, 2021. CMS and OIG coordinated many aspects of the value-based rules, and this section …
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The Regulatory Sprint to Value-Based Care: The New Safe Harbors and Stark Exceptions
On November 20, 2020, the Centers for Medicare & Medicaid Services (“CMS”) and the Office of the Inspector General (“OIG”) finalized the rules modifying the safe harbors under the Anti-Kickback Statute and exceptions under the Stark Law. These new rules take effect as of January 19, 2021. Due to their complexity, this article will focus …
The OIG’s FAQs Related to COVID-19
The Office of the Inspector General (“OIG”) for the Department of Health and Human Services (“HHS”) has developed a process for interested parties to obtain regulatory compliance guidance from the OIG prior to pursuing arrangements related to COVID-19. The OIG has dubbed this process FAQs–Application of OIG’s Administrative Enforcement Authorities to Arrangements Directly Connected to the Coronavirus Disease …
Michigan Governor Rescinds Some and Extends Other Scope of Practice Rules
On July 13, 2020, Michigan Governor Gretchen Whitmer issued Executive Order (“EO”) 2020-150, which renewed and, at the same time, rescinded different relief measures previously granted to health care professionals in Michigan during the COVID-19 state of emergency. On April 1, 2020, to increase access to care in response to COVID-19, the Governor issued EO …
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Summary of Key Changes to Rules Implementing ACA Nondiscrimination Provisions
On June 19, 2020, the Department of Health and Human Services (“HHS”) released its final rule[i] (the “Final Rule”) revising its enforcement of Section 1557 of the Patient Protection and Affordable Care Act (“ACA”).[ii] In this rule, HHS reversed many of the requirements of the prior rule issued in 2016 (the “2016 Rule”).[iii] For example, the Final Rule …
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