Recent Blog Posts
How Breaching HIPAA Could Impact Your Professional Practice
The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that governs how private healthcare information must be maintained, including how it can be stored and transferred. HIPAA sets a host of requirements for healthcare practices, including training, data security, and private health information (PHI) disclosure. The requirements are strict, and violating… Read More »
Red Flags That Can Trigger DEA Investigations (Raids) on Your Healthcare Practice
Healthcare practices are subject to a laundry list of regulations at the local, state, and federal levels. Any misstep can lead to oversight and investigations by an alphabet soup of regulatory agencies. Regulatory and legal compliance is key to maintaining best practices and avoiding the unnecessary stress, money, effort, reputational damage, and potential liability… Read More »
Civil Monetary Penalties: What Should Providers Do When DOJ Imposes Monetary Penalties
When the Department of Justice (DOJ) has evidence of unlawful conduct–whether that takes the form of unlawful kickbacks, billing fraud, illegal prescribing, or other fraud and compliance issues–they may pursue an enforcement action. If the DOJ finds that their allegations are justified, they may impose significant civil penalties on healthcare entities and/or individual owners… Read More »
How Regulation Influences Health Policy
Healthcare providers deal with more regulation than professionals in just about any other industry. What are the effects of that regulatory system? Does the heavy-handed approach to medical regulation serve to increase the quality of care to patients, or to expand access to healthcare for people across the country? Below, we review the effects… Read More »
Protecting Your Healthcare Organization from False Claims Act Liability After CARES Act Funding (PRF)
The federal government enacted the Coronavirus Aid, Relief, and Economic Security (CARES) Act to help individuals and businesses adversely impacted by the novel coronavirus pandemic. In April 2020, the Department of Health and Human Services (HHS) announced a plan to distribute $175 billion in relief funds authorized by the CARES Act and subsequent relief… Read More »
False Claims Act (31 US Code ยง 3729): What Are the Penalties?
The False Claims Act (FCA) prohibits parties from defrauding the government. Medicare and Medicaid fraud fall under the ambit of the FCA, as do other forms of overbilling and fraud that impact government agencies or entities. The penalties for a scheme of violating the FCA can be severe. Read on to learn about civil… Read More »
What Physicians and Healthcare Organizations Should Know About Asset Forfeiture
Pursuant to federal law, the government has the authority to freeze or force parties to forfeit assets in their possession in advance of criminal prosecution or civil litigation. The government can seize accounts, freeze accounts, and take other actions against healthcare providers in connection with healthcare fraud litigation. Asset freezes and forfeiture can have… Read More »
As a Doctor, Do I Self-Report a DUI to the Licensing Board?
Licensed professionals are held to a higher standard than individuals in other occupations. Maintaining a professional license means keeping up with ongoing education, paying license fees, and avoiding regulatory or legal trouble. Doctors are held to especially high standards, even among professionally-licensed occupations. Certain criminal convictions can lead to sanctions or even license revocation…. Read More »
Medicaid Fraud Investigation: The Process & Penalties
While Medicaid is funded at the federal level, it is a state-administered program. Forty-nine states including the District of Columbia have Medicaid Fraud Control Units. These MFCUs are state law enforcement agencies and are typically a part of the state’s attorney general’s office. MFCUs are separate entities from state Medicaid programs. Still, these two… Read More »
What is Considered a Kickback in Healthcare
Healthcare professionals are perhaps more regulated than professionals in any other industry. Even minor oversights can lead to significant liability to patients, insurance providers, and the government. Unlawful conduct perpetrated by physicians and other medical professionals is often punishable with serious criminal charges. Even conduct that is perfectly acceptable in other industries is criminal… Read More »