OIG: Pediatric Clinic Can Provide Routine Cost-Sharing Waivers

A surgeon holding up a stethoscope with a dollar sign on it.

A pediatric clinic that provides medical, psychiatric and dental care to low-income children can waive cost-sharing amounts for patients in financial need, even though the arrangement does not meet the regulatory exception for permitted waivers of cost-sharing amounts under the Civil Monetary Penalties Law, according to an Advisory Opinion issued by the Health and Human…

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Court Rules Against United’s Offsetting Policy

A pair of hands holding money with two fingers on each other.

UnitedHealth Group’s policy of withholding payments to out-of-network physicians and doctors in order to recover previous overpayments – a practice known as cross-plan offsetting – is not permissible and may even violate The Employee Retirement Income Security Act (ERISA). That was the long-awaiting ruling from the Eighth Circuit Court of Appeals issued last week. The…

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Government cracking down on drug company ties to charities

A dollar sign sitting on top of many pills.

Actelion Pharmaceuticals, a San Francisco-based biopharmaceutical company, recently agreed to pay $360 million to resolve allegations it provided kickbacks to a charitable organization through contributions it made, and that the charity turned around and used those contributions to pay the copays of patients using Actelion’s drugs. Drug makers are not permitted to make Medicare patient…

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The Granston Memo One Year Later

A scale with a money bag and cannon on it.

Last year, we wrote about an internal memo from the U.S. Department of Justice addressing the dismissal of qui tam (whistleblower) cases. The Granston Memo, so named because it was written by DOJ’s Director of Civil Fraud Section Michael Granston, outlined various factors government prosecutors should use to evaluate whether a False Claims Act (FCA)…

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