In the wake of the #MeToo movement, most employers have become more acutely aware of the risks involved in failing to effectively prevent and respond to claims of workplace harassment. This renewed awareness should cause all employers, large and small, to evaluate their policies, processes and practices in place to prevent harassment and to respond …
Launch of the Criminal Division’s In-House Health Care Data Analytics Team
In its “2017 Year in Review” (https://www.justice.gov/criminal- fraud/file/1026996/download), the Fraud Section in the Criminal Division of the US Department of Justice announced the launch of its Health Care Fraud Unit’s Data Analytics Team. While the use of data analytics is not new to the Department of Health and Human Services and civil enforcement section of …
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As Telemedicine Soars, Reimbursement for Telemedicine Services Slowly Evolve
The use of telemedicine has soared in recent years, as new technologies develop and consumer demand for instant access to healthcare increases. Indeed, the telemedicine market is expected to grow to $113.1 billion by 2025, at an estimated compound annual growth rate of 18.8%. It is expected that at least 7 million patients in the …
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The Trump Administration Proposes a Budget Increase to Fight Healthcare Fraud
The Trump administration proposed a budget increase of 19 million to aid in the fight against health care fraud. This showcases the continued (and heightened) importance of anti-fraud programs, especially compared to the suggested $18 billion in cuts to other health-care related programs. If approved by Congress, the budget increase will result in an increase …
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Obligations and Expectations Surrounding Healthcare Compliance Programs
The phrase “healthcare compliance program” is commonly used to describe those processes and procedures implemented by a healthcare provider to prevent submission of erroneous claims and combat fraudulent conduct. The expectation is that providers using internal controls will more efficiently monitor adherence to legal and regulatory requirements than providers without such controls in place1. However, …
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The Patent Mirage: The New Challenge for Today’s IP Strategy
Rose Willis (Member, Saginaw and Troy) states “Innovators in the healthcare industry must protect their technology and innovation property rights. Dickinson Wright healthcare intellectual property attorney, Lance Anderson (Member, Austin), provides strategies and other valuable insight into the methods of protection in his article “The Patent Mirage: The New Challenge for Today’s IP Strategy”. Effectively …
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Is Your Physician Organization Complying with Antitrust Law?
It is not uncommon for a physician organization to act as an intermediary between its physician participants and third-party payers to facilitate the negotiation and acceptance of reimbursement rates and other payer contract terms. However, when facilitation becomes negotiation and a PO accepts contracts with third-party payers on behalf of physician participants, also known as …
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Prescription for Fraud: Government Enforcement Activities in Compounding Pharmacies
On October 18, 2017, a Mississippi physician was charged with health care fraud for writing prescriptions for medically unnecessary compounded medications. This is the latest – though certainly not the last – example of the Department of Justice’s efforts to combat fraud within the TRICARE program. From California to Florida, federal prosecutors have charged physicians, …
Blessings in Disguise: Hidden Opportunities in Health Care Bankruptcies
In 2016 alone, 21 hospitals were closed across the United States because of unsustainable financial performance1, and the trend has continued with 7 additional hospitals and 18 other hospital departments closing in just the first half of 20172. Financial challenges facing many entities in the health care industry are not limited to hospitals, or even …
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Caution As To Compensation Paid By Professional Corporations
Two recent Tax Court cases raise caution flags as to the deductibility of shareholder compensation by medical, dental and other professional practice groups organized as professional corporations (PCs) or professional associations (PAs) that are taxed as “C” corporations for federal tax purposes. In each case, on audit, the IRS sought to disallow deductions for a …
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