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Keeping you afloat amidst the rising sea of regulations

CMS’s Long-Awaited Final 60-Day Repayment Rule Provides Guidance and Eases Some Requirements for Health Care Providers and Suppliers

On Friday, February 12, 2016, the Centers for Medicare and Medicaid Services (CMS) released the long-awaited Final Rule and regulations,[1] providing much needed guidance to providers and suppliers on how to meet the Affordable Care Act’s (ACA’s) 60-day overpayment mandate.[2] Specifically, a provision enacted as part of the ACA in 2010 requires that all Medicare and Medicaid overpayments be reported and returned by the later of (i) 60 days after the date on which the overp

CVS Settles Controlled Substances Act Claim for $8 Million

As part of the federal government’s multi-front attack on opioid abuse, the Department of Justice announced on Friday, February 12 that CVS Pharmacy, Inc. has agreed to pay $8 million to settle allegations that it violated the Controlled Substances Act (CSA).

The End at Last: Tuomey Settles for $72.4 Million

The Department of Justice recently announced that Tuomey Healthcare System has agreed to pay $72.4 million and enter into a five-year Corporate Integrity Agreement to finally resolve the long-running U.S. ex rel., Drakeford v. Tuomey Healthcare System, Inc. False Claims Act/Stark Law litigation, a case that has included two jury decisions and two appeals to the Fourth Circuit.

Covered Entities and Business Associates Beware! New HIPAA Audits to Begin in Early 2016

Health care providers and their contractors have been put on notice by the Office for Civil Rights (OCR) that the next round of HIPAA compliance audits will begin in early 2016. The previous round of HIPAA audits was completed in 2014. While OCR previously had signaled that the HIPAA audits would be resuming in the near future (such as by noting the upcoming release of a new audit protocol), OCR’s new statement is the most definitive information curr

Stark Law is Coming: Adventist Health System Pays $118.7 Million in Third Large September Settlement

On September 21, 2015, the US Department of Justice (DOJ) and whistleblowers’ counsel announced that Florida-headquartered Adventist Health System (Adventist) had agreed to pay $118.7 million to resolve allegations that it violated the False Claims Act (FCA) by submitting claims in v

Deputy AG Branda Provides Insights into Department of Justice Enforcement Priorities at AHLA Fraud and Compliance Forum

Joyce Branda, the Deputy Assistant Attorney General for the Commercial Litigation Branch of the Department of Justice (DOJ), gave the keynote address on September 28, 2015, at the American Health Lawyers Association Fraud and Compliance Forum in Baltimore, providing conference attendees with an update from DOJ. Her speech identified various key issues for DOJ, as well as areas in which the health care industry can expect to see increased scrutiny in the coming year.

Arent Fox Represents North Broward Hospital District in High Profile False Claims Act Settlement

Washington, DC — On September 15, the US Department of Justice announced that it reached a $69.5 million settlement with the North Broward Hospital District to resolve False Claims Act allegations that originated in 2010.

First In Kind False Claims Act Settlement Based Upon Failure to Investigate and Return Overpayment

Earlier this week, BNA’s Health Care Daily Report picked up on the announcement of a settlement in two False Claims Act cases. (United States ex rel. Odumosu v. Pediatric Servs. of Am. Healthcare, N.D. Ga., No. 1:11-cv-1007; United States ex rel. McCray v. Pediatric Servs. of Am., S.D. Ga., No.

Midsummer Nightmare: Opinion in Continuum Health Partners Case Suggests We Can Identify the Unknown

On Monday, a federal district court judge in New York issued a ruling that, if adopted broadly, will have a significant – and potentially nightmarish – impact on any provider who receives an overpayment from Medicare or Medicaid. Kane v. Healthfirst, Inc. and U.S. v.

Physicians (and other Providers) Beware! OIG Announces New Enforcement Team Focused on CMPs and Exclusion

Last week, at the annual meeting of the American Health Lawyers Association in Washington, DC, the U.S. Department of Health and Human Services Office of Inspector General (OIG) announced the creation of a new litigation team focused solely on using the OIG’s authority to impose civil monetary penalties and exclude individuals and businesses from Medicare and Medicaid. Located within the Office of Counsel to the Inspector General (OCIG), the unit debuted in March and is expected to have 10 attorneys when fully up and running.