Compliance Update

A man who dubbed himself a “serial entrepreneur” is the target of a complaint alleging he violated the False Claims Act by submitting more than 24,000 false claims to Medicare for more than 300,000 respiratory pathogen panel tests that were not ordered by healthcare providers, not medically necessary, or never performed. The defendants billed and received more than $7 million in reimbursement...

In 1996, the Mental Health Parity Act required insurance companies to provide the same benefits for substance abuse and mental healthcare services as they do for ordinary medical care. In 2010, the Affordable Care Act imposed penalties for not providing such comparable coverage. Due to the expansion in requisite coverage, there has been an expansion in the number of addiction treatment...

Inadequate oversight by the Centers for Medicare & Medicaid Services (CMS) of payments for the highest paid genetic test risked up to $888 million in improper payments, according to a recent audit by the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG). OIG reviewed Medicare Part B claims for more than 450,000 genetic tests billed under CPT code 81408...

When getting ready to hire workers such as doctors, mid-levels or administrative staff, you might be wondering if you should classify them as an employee or independent contractor. The IRS, Fair Labor Standards Act and common law have helped to differentiate between the two and doing so is important as misclassification can injure both the hire and you as the employer. Employee The general rule...

Just days before the COVID-19 Public Health Emergency (PHE) was about to expire on May 12, The Drug Enforcement Administration (DEA) and Substance Abuse and Mental Health Services Administration (SAMHSA) issued a temporary rule that extends flexibilities for prescribing controlled substances via telemedicine. More than 38,000 public comments were made in response to a proposed rule issued on...

Increasing concerns about underpayment and non-payment by insurance companies have providers focused more than ever on cash services. Many of the active and emerging players in the med spa, IV hydration therapy, and concierge medicine spaces are misguided on the issue of compliance, however. Both legal exposure and health care regulatory compliance create real risk, even in the cash pay space....