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Understanding Insurance Audits in the Health Care Industry

Posted on Health Care Law News August 5, 2022 by Rachel Broughton

Aggressive insurance audits have become increasingly common within the health care industry, and all health care providers who bill insurers are susceptible to audits from those payers, whether it be the government (such as Medicaid or Medicare) or private insurance companies. While private insurance companies each have their own policies and procedures with respect to Read more →

US DOJ Announces Criminal Charges for $1.2 Billion in Telemedicine, Cardiovascular and Cancer Genetic Testing and DME Fraud

Posted on Fraud Investigation, Health Care Law News July 21, 2022 by Rachel Broughton

On Wednesday, July 20, 2022, the United States Department of Justice (DOJ) announced criminal charges against 36 defendants in 13 federal districts across the United States for more than $1.2 billion in alleged fraudulent telemedicine, cardiovascular and cancer genetic testing, and durable medical equipment (DME) schemes. In connection with the enforcement action, the department seized Read more →

Navigating the Broad Implications of EKRA in the Substance Abuse and Diagnostic Laboratory Testing Industries

Posted on Fraud Investigation, Health Care Law News July 19, 2022 by Rachel Broughton

The Eliminating Kickbacks in Recovery Act, otherwise known as EKRA, is a fairly new federal law that targets patient brokering and recovery profiteering. EKRA broadly makes it a federal crime for anyone, with respect to services covered by any health care benefit program, to knowingly and willfully: solicit or receive any remuneration (including any kickback, Read more →

US Supreme Court Rules There Is No Criminal Liability Under the Controlled Substance Act For Physicians Who Act in Subjective Good Faith

Posted on Health Care Law News, Professional Licensure Investigations July 1, 2022 by Rachel Broughton

 On June 27, 2022, the Supreme Court of the United States ruled that physicians who act in subjective good faith when prescribing controlled substances to their patients are shielded from criminal liability under the Controlled Substances Act (CSA).  This decision will make it much more difficult for prosecutors to convict medical professionals under the CSA Read more →

Healthcare Professionals Beware: Genetic Testing Enforcement is On the Rise

Posted on Fraud Investigation, Health Care Law News, Medicare Reimbursement June 17, 2022 by Rachel Broughton

Genetic testing, when medically necessary, can provide physicians with important information for the diagnosis, prevention, and treatment of numerous illnesses. It has become an extremely valuable tool in many fields of medicine and can play a significant role in the overall medical care that a patient receives. In recent years, genetic testing has become heavily Read more →