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In addition to funding the government and further COVID-19 relief, the recently signed Consolidated Appropriations Act (CAA) included significant provisions impacting health benefit coverage.
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With the start of the Biden administration and a DOJ very likely led by Merrick Garland, predictions have begun about future trends in government enforcement. Two pieces of conventional wisdom emerge: First, the focus will shift to more white-collar crime enforcement actions. And second, the healthcare industry will continue to be a major focus for investigators and prosecutors.
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The federal government won or negotiated over $2.6 billion in healthcare fraud judgments and settlements in 2019. The government's investment of resources toward combatting fraud, waste and abuse in healthcare can be expected to continue in full force, irrespective of a change in political administration. Accordingly, it is important for healthcare companies to focus on maintaining flexible and effective compliance programs.
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The healthcare industry is facing an alarming proliferation of cyber perils. Why? Because our healthcare system is a "soft target," and particularly vulnerable because of its lifesaving work, where time is of the essence. It's a recipe for disaster from a cybersecurity standpoint.
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Many community hospitals are in distress. The causes are varied but have a constant theme — the cost to adapt to a rapidly changing environment.
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<b><i>Lessons Learned from Recent Settlements and Decisions</b></i><p>Health care fraud and False Claims Act cases continue to generate a significant source of funds for the Federal Government.Although, when announcing its focus, the government listed treatment options are not always clear. What these settlements often have in common is that the underlying complaints allege that the services that were rendered and reimbursed lacked medical necessity.
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Many community hospitals are in distress. The causes are varied but have a constant theme — the cost to adapt to a rapidly changing environment.
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The FDA's recent approval of 23andMe's direct-to-consumer genetic test to identify genes associated with 10 common diseases and disorders could result in a widespread expansion of patients armed with individualized health information. This expansion of genetic information in the hands of consumers potentially impacts regulatory and litigation issues for pharmaceutical companies.
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As of July 1, 2017 all employers in Arizona are now required to provide employees with paid sick leave as directed by a new law, the Fair Wages and Healthy Families Act. The law dictates how employers must implement the new rules — from when the benefits begin to accrue to when they pay out, and what fines will be imposed for non-compliance.
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The DOJ continues to prioritize health care anti-fraud enforcement through the aggressive use of different statutes and investigative methods. Now, the government is putting a 60-year-old tool to a new use: It is using the federal Travel Act to pursue criminal charges against health care entities in connection with health care bribery/kickback schemes. This article discusses these recent actions and the potential ramifications of the expansion of the scope of the Travel Act.