Regulatory Compliance

Latest Headlines

Latest Headlines

CMS drafts new rules to limit home health fraud

The Centers for Medicare & Medicaid Services has proposed a rule that would allow the agency to collect baseline data on probable fraud payments in the home health industry and launch a preauthorization pilot project in five states.  

CMS clarifies 60-day rule, lookback period for overpayments

The Centers for Medicare & Medicaid Services has finalized rules that specify when the 60-day clock begins ticking for providers to return overpayments, and shaves four years off of the overpayment lookback period, according to  FierceHealthFinance.  

New Mexico clears 10 behavioral health providers of fraud accusations

Nearly three years after the New Mexico Human Services Department cut off Medicaid funding to 15 behavioral health providers, Attorney General Hector Balderas has cleared 10 companies of criminal fraud allegations, his office announced Monday.    

Legislators take aim at Stark law in light of value-based payment changes

Legislators are asking industry stakeholders for input regarding potential changes to. Stark law in light of the ongoing transition towards value-based payments, according to a report by Bloomberg BNA.

Provider groups urge Supreme Court to overturn FCA decision

More than a dozen organizations submitted amicus briefs to the Supreme Court last week, imploring the court to overturn a False Claims Act decision that relies on a broach interpretation of "implied certification," according to case updates on  SCOTUSblog.  

Former CEO claims he was fired for calling out improper payments

A prominent physician and former CEO of an Oregon health system says he was fired by the governing board last year for suggesting the provider self-report $10 million in improper Medicare claims, according to  The Oregonian,

Payers are ramping up addiction treatment audits

Health payers are intensifying investigations into addiction treatment services with more comprehensive records requests, according to one healthcare attorney.

PharMerica and the terrible, horrible, no good, very bad year

Last year was a terrible, horrible, no good, very bad year for PharMerica Corp., the second largest pharmacy operator in the country that ended up spending $43.25 million to resolve multiple False Claims Act allegations from the federal government. In the span of 12 months, the company negotiated multi-million dollar settlements and entered into another corporate integrity agreement for accepting kickbacks and illegally dispensing drugs. 

Amid a handful of overprescribing convictions, one doctor has a 30-year fraud history

A psychiatrist indicted for illegally selling prescriptions for nearly 10,900 pain pills has a history of illegal prescribing practices and Medicare fraud dating back 30 years, according to

Fraud trends: FCA cases, physician pay will loom large in 2016

With fewer False Claims Act recoveries, some might say 2015 was a down year for federal fraud enforcement. But attorneys across the country say federal policy changes and FCA trends will keep fraud concerns high on the government's radar in the coming year.