Can Overpayments Create Criminal Liability?

We hear a lot about potential liability under the False Claims Act (FCA) for the failure to repay overpayments within 60 days of discovery. Focus on the 60-day rule has taken focus away from the potential for criminal charges for retaining known overpayments.  Section 1128B(a)(3) of the Social S...

Defining the Duty of the Board of Directors over Compliance Functions

Compliance Program Oversight by Board of Directors I recently posted a blog article about a document released by the Department of Justice entitled “Evaluation of Compliance Programs.”  As the title of the document might suggest, the DOJ release covers a variety of issues it looks at when ev...

Revision to Medicare oversight or provider based status.

Hospital Provider Based Status Review OIG 2016 Work Plan Coverage   There’s a lot of activity in the area of provider based facilities and hospitals outpatient departments. Laws are changing to equalize reimbursement that is available between provider-based and physician office settings. Service...

New 2016 Work Plan Indicates Area of Compliance Focus

OIG 2016 Work Plan Highlights Areas of Fraud and Abuse Concern Each year the Office of Inspector General puts out a work plan that indicates the priorities that it will look up at during the upcoming year. The OIG is an organization that was created to protect the integrity of the HHS program ope...

Ambulatory Surgery Center Forced Exclusions – lets be honest for a minute, shall we?

Excluding Non-performing Positions from a Physician Owned Surgery Center   Many surgery centers are eventually faced with decisions about how to treat investing physicians who do not perform as many procedure procedures in the surgery center as others.  Under-performing physicians can create pol...