Medicare Fraud Strike Force Sends Strong Message on Fraud and Abuse

Highlighting its continued focus on cracking down on Medicare fraud and abuse practices, the U.S. Department of Justice and the U.S. Department of Health and Human Services announced this month the largest ever health care fraud enforcement action precipitated by the Medicare Fraud Strike Force. As part of this national health care fraud takedown, the government charged 412 defendants with approximately $1.3 billion [...]

By |2017-10-10T13:03:18-06:00July 27, 2017|

What You Need to Know About Granny Cams

Cameras placed in the rooms of residents at skilled nursing or assisted living facilities, otherwise known as granny cams, are becoming more commonplace. Lawsuits against staff members at such facilities are also increasing because of disturbing footage found on the cameras.  However, there are currently no federal laws (other than applicable criminal laws) in place to regulate their use and [...]

By |2017-07-06T13:33:43-06:00July 5, 2017|

New Legislation to Affect Colorado Medical and Dental Providers in August

Many health care professionals struggle with traditional models of patient care because of limitations on reimbursement imposed by insurance companies. When they are forced to rely on insurance companies and federally funded programs such as Medicare and Medicaid to determine coverage and reimbursement rates, these health care professionals are stretched thin. To cover overhead costs, they often schedule as many [...]

By |2017-06-28T13:09:12-06:00June 28, 2017|

Health Care and the 2017 Colorado Legislative Session

Note: Josiah Beamish, J.D., a health law clerk for Caplan and Earnest, was instrumental in compiling this information. The 2017 Colorado Legislative Session resulted in some key pieces of health care legislation, which allowed the legislature to address several long-term needs in the state’s health care system. One of the biggest developments this legislative session is the commitment to supporting [...]

By |2017-06-09T13:55:50-06:00June 6, 2017|

Understanding “Incident To” Billing

Section 1861(s)(2)(A) of the Social Security Act allows physicians to bill Medicare for patient services provided “incident to” a physician’s services. “Incident to” services are furnished incident to physician professional services in the physician’s office or in certain other locations.  These services are typically performed by non-physician practitioners (NPPs), such as a nurse practitioner or physician’s assistant.  The services, which [...]

By |2017-06-09T14:03:09-06:00June 1, 2017|

Lance Armstrong, the False Claims Act and $100 Million

If you had told me five years ago that someday a qui tam case would be filed against Lance Armstrong for his use of performance enhancing drugs (PEDs) while a member of the United States Postal Service (USPS) professional cycling team, and that the case would provide insight into the government’s theories of liability under the False Claims Act (FCA), [...]

By |2017-03-17T09:11:47-06:00March 17, 2017|

OIG Expands Exclusion Authorities Under Final Rule

On January 12, 2017, the Department of Health and Human Services Office of Inspector General (OIG) issued its Final Rule regarding its authority to exclude individuals and entities from participation in the Federal health care programs. The Final Rule, which takes effect on February 13, 2017, clarifies and expands the OIG’s exclusion authority under the Affordable Care Act (ACA). Statute [...]

By |2017-01-26T09:03:48-06:00January 24, 2017|

Summary of 2016 Legislative Developments in Health Care

As 2017 quickly approaches, and we prepare for the next legislative cycle, our team wanted to provide an update and overview of the important health care legislation that took place in 2016. HB16-1081 Statutory Reporting Requirements – Repeal Obsolete Provisions. This new law repeals several of the Department of Health Care Policy and Financing’s current requirements. Although not an exhaustive [...]

By |2016-12-27T11:06:17-06:00December 27, 2016|

HHS and CMS Adjust Civil Monetary Penalties by More Than Double

Maximum civil monetary penalties for skilled nursing providers, home health agencies and clinical labs more than doubled under a final rule released by the Department of Health and Human Services and the Centers for Medicare & Medicaid Services. The rule, which implements the Federal Civil Penalties Inflation Adjustment Act of 2015, adjusts the penalties to reflect inflation and “maintain their [...]

By |2017-03-14T15:36:04-06:00October 28, 2016|