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Sen. Rubio to Introduce Bill to Crackdown on Florida Shuffle

Have you heard of the Florida Shuffle? It’s not a new dance step, it’s what they call it when substance abusers come to Florida to get clean, leave treatment, continue using and come back again, all the while having their treatment paid for by insurance. Florida is, according to published reports, the nation’s second most […]

Common Healthcare Fraud Schemes

Last month’s indictment of more than 600 people nationwide in what the feds dubbed “the largest healthcare fraud takedown in history,” should serve as a warning that the government is serious about cracking down on those who abuse the system. As we wrote about in June, of the 601 defendants charged, 165 were medical professionals […]

HIPAA Violation Results in $4.3M Fine for Cancer Center

If you haven’t taken stringent measures to protect patient privacy, this recent ruling from a U.S. Department of Health and Human Services Administrative Law Judge might spur you into action. The ALJ ruled that University of Texas MD Anderson Cancer Center violated HIPAA Privacy and Security Rules and granted summary judgment to the Office for […]

Doctors, Nurses, Other Healthcare Pros Rounded up in Opioid and Medicare Fraud Sweep

Doctors, nurses, addiction treatment professionals, pharmacists and hundreds of others are among the 601 people across 58 federal districts charged this week in what the Justice Department is calling “the largest national healthcare fraud enforcement action” in its history. The fraud resulted in more than $2 billion in losses. Of those 601, more than 162 […]

Do you Know Your Obligations Under the Medicare Secondary Payer (MSP) Provisions?

A Philadelphia-based personal injury law firm has paid $28,000 to settle allegations that it failed to reimburse the government for Medicare payments made to healthcare providers on behalf of its clients. The agreement should serve as a reminder to personal injury lawyers and others of their obligation to reimburse Medicare for conditional payments after receiving […]

Advisory Opinion: Clinic Can Provide Free Telemedicine Equipment, Services

A nonprofit, federally qualified health center look-alike (FQHC) can use grant funds to provide telehealth equipment and services for free to facilitate encounters with patients of a county-run clinic that provides testing, treatment and counseling for HIV, based on a recent advisory opinion issued by the Department of Health and Human Services Office of the […]

CMS Policy Changes to Drug Benefit Program Targets Opioid Abuse

Effective June 15, policy changes for the prescription drug benefit program finalized by the Centers for Medicare & Medicaid (CMS) take effect. CMS published the final rule updating Medicare Advantage (MA) and the prescription drug benefit program (Part D).  The new rule is expected to result in nearly $300 million in annual savings over five […]

OIG Opinion: Providing Sample Ostomy Products Does not Violate Anti-Kickback Statute

An ostomy product distributor can give free samples to Medicare patients without worrying about violating the federal Anti-Kickback Statute, according to a recent advisory opinion from the Office of Inspector General for the U.S. Department of Health and Human Services. The Anti-Kickback Statute makes it a criminal offense to knowingly and willfully offer, pay, solicit […]

CMS Wants to Revive Controversial HHA Claim Review Process

The Centers for Medicare & Medicaid Services (CMS) wants to revive a controversial demonstration project for Medicare fee-for-service home health that it says is designed to reduce fraud. What was supposed to be a three-year project, starting in Illinois and expanding to several other states, including Florida, launched in 2016. The idea was for providers […]

Nationwide Push on to Remove Gag from Pharmacists

If some U.S. lawmakers have their way, gag clauses that prohibit pharmacies from telling customers how they can save money on their prescription drugs could be prohibited nationwide, a move that supporters say will result in more transparency and lower costs. On June 20, the Senate Health Committee is set to vote on a bipartisan […]

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It is not intended as professional advice and should not be construed as such.