If you’re preparing to launch an audit within your healthcare organization, pause for a moment and consider this: how well you plan before the audit begins can significantly affect the outcome—and your risk exposure. This...more
Physician compensation benchmarks like those from the Medical Group Management Association (MGMA) or the American Medical Group Associations) AMGA are commonly used in the healthcare industry. Organizations lean on them for...more
In today’s complex healthcare landscape, whistleblower claims are a major source of regulatory and legal risk for organizations. Last year saw a record number of “qui tam” claims filed under the False Claims Act. While...more
In April, a pharmaceutical manufacturer agreed to pay a $202 million settlement to resolve allegations of Anti-Kickback Statute (AKS) violations. At the heart of the case were speaker programs, where physicians and...more
Cash-based practices, or providers who neither participate with nor bill insurers, are becoming increasingly common, especially in certain specialties such as primary care, women’s health, and mental health. While providers...more
5/1/2025
/ Beneficiaries ,
Compliance ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Insurance Claims ,
Medicare ,
Mental Health ,
Physicians ,
Regulatory Requirements ,
Reimbursements
Healthcare providers often have a detailed policy outlining when a minor may consent to care and when a parent or legal guardian’s consent is needed. Situations can arise in the treatment of minors that can make administering...more
In January, the Department of Justice released its annual fraud statistics summarizing health care fraud settlements and judgments during the 2024 fiscal year. Last year, there were over $2.9 billion in fraud settlements and...more
2/27/2025
/ Anti-Kickback Statute ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Physician Payments ,
Physicians ,
Settlement ,
Stark Law ,
Whistleblowers
As we routinely discuss on the podcast, much of the success of an organization’s compliance program depends on its culture. Creating and fostering a compliance-minded culture can help ensure employees report suspected...more
Healthcare workers nationally are facing an increase in workplace violence, often instigated by patients and visitors. A study published earlier this year reported that almost 20% of healthcare workers have faced physical...more
10/17/2024
/ Employer Liability Issues ,
Essential Workers ,
Health and Safety ,
Health Care Providers ,
Healthcare ,
Healthcare Facilities ,
Healthcare Workers ,
Nurses ,
Patients ,
Physicians ,
Termination Rights ,
Workplace Safety ,
Workplace Violence
Looking for a simple, easy-to-implement way to lower your risk of overpayments? We have one on this week’s podcast!...more
Providers will often pay physicians for serving in important administrative roles within the organization. Compensation for administrative services can create risk to the organization under multiple laws, including the...more
We often work with valuation experts to ensure compensation payments between healthcare organizations and physicians are fair market value and commercially reasonable for purposes of compliance with the Stark Law and the...more
4/26/2024
/ Anti-Kickback Statute ,
Compliance ,
Fair Market Value ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Physicians ,
Settlement ,
Stark Law ,
Valuation ,
Whistleblowers ,
White Collar Crimes
On December 2, 2022, Health & Human Services issued guidance (HHS) delaying the requirement that convening providers include co-provider charges in their good faith estimates for self-pay patients. Previously, the requirement...more
In 2020, Congress passed the No Surprises Act (NSA) in an attempt to protect patients from surprise billing. Some sections of the NSA became effective January 1, 2022, while other sections are on hold until regulations are...more
The United States Department of Justice (DOJ) has filed another False Claims Act case against a long-term care provider premised on the quality of care provided to its residents. The DOJ is increasingly utilizing substandard...more
The use of telehealth and remote communication technologies has skyrocketed since the start of the COVID-19 pandemic. At the beginning of the pandemic, the Office of Civil Rights for Health and Human Services (“OCR”) notified...more
Although we remain hopeful that Iowa will be spared the worst of the COVID-19 pandemic and health care resources will be sufficient to care for all patients in need, we encourage hospitals and hospital-based physicians to...more
Q: Should we postpone elective surgeries?
A: Yes. On March 18, 2020, CMS released recommendations urging hospitals and physicians to postpone elective surgeries and services....more
November, a federal district court granted partial summary judgment for the Department of Justice in U.S. ex. Rel. Baklid-Kunz v. Halifax Medical Center, ruling that productivity bonuses paid to employed physicians violated...more
Yesterday the Office of the Inspector General (OIG) released a special fraud alert addressing physician ownership in entities that derive revenue from implantable medical devices. While such arrangements are not per se...more