You've seen the commercials: a happy elderly person
celebrates his freedom: eating dinner with the family, going to the
park with the grandkids, making himself a snack! All thanks to the
power wheelchair which he obtained free (or at minimal cost)!
But there is a dark side to the power wheelchair story. Improper
payments, waste, and fraud - unfortunately, these problems are all
too common. A recent report by the Medicare Office of Inspector
General ("OIG") found that 61 percent of power
wheelchairs provided to Medicare beneficiaries in the first half of
2007 were either medically unnecessary or lacked sufficient
documentation to determine medical necessity. These power
wheelchairs accounted for $95 million – nearly one-half
of the $189 million that Medicare allowed for power wheelchairs
during this period....
Specific Questions relating to this article should be addressed directly to the author.
This third, and final, installment in the "Year in Review" series examines how criminal health care fraud enforcement has changed in the past year, including the use of non-health-care-related statutes, the focus on specific industries, and the increased number of alleged violators targeted in takedowns.
On May 4, 2012, the Centers for Medicare and Medicaid Services ("CMS") announced that it will not require applicable manufacturers and group purchasing organizations ("GPOs") to begin collecting data on relevant payments under the Physician Payment Sunshine Act until January 1, 2013.
An investigation by the HHS Office for Civil Rights was triggered by a report that the PC was posting clinical and surgical appointments for its patients on an internet-based calendar that was publicly accessible.
The Office for Civil Rights (OCR) of the Department of Health and Human Services (HHS) has just sent another strong signal to healthcare providers and plans that it intends to enforce the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules aggressively, and that it does not intend to give a pass to small healthcare providers or practices.
Last month the U.S. Department of Health and Human Services, Office of Inspector General (OIG) issued Advisory Opinion No. 12-02, which favorably analyzed an arrangement whereby healthcare providers offer discount coupons for their medical services and products to patients by posting them on a website.
On December 19, 2011, the U.S. Centers for Medicare & Medicaid Services (CMS) published a proposed rule to implement the Physician Payments Sunshine Act, which was included as part of the Patient Protection and Affordable Care Act of 2010.
In this first installment of Mintz Levin’s Health Care Fraud Enforcement Defense Group’s periodic updates on health care enforcement activities in 2012, Brian Dunphy, Hope Foster, Samantha Kingsbury, Tracy Miner, and Stephanie Willis focus on significant civil settlements, criminal prosecutions, and regulatory developments that occurred in the first quarter of 2012.
This week, the Seventh Circuit issued a decision in Schaffer-Larose v. Eli Lily & Company, in which it held that pharmaceutical reps are exempt under the FLSA's administrative exemption.
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