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One month from today, the law that permits independent laboratories to bill and receive payment from Medicare Part B for the technical component of certain anatomic pathology, cytopathology, and surgical pathology services ("TC Services") provided to patients of "covered hospitals" will expire.
The Office of Inspector General for the Department of Health and Human Services (OIG) has released its 2012 Spring Semiannual Report (Report) on the legal review, monitoring, and prosecution-related activities undertaken by the agency between October 1, 2011 and March 31, 2012.

Keeping the Whistle Away from the Whistleblower

May 24, 2012 | Blog | By Karen Lovitch

The G2 Compliance Report recently published a very informative article written by Hope Foster, Leader of Mintz Levin's Health Care Enforcement Defense Practice, on the whistleblower's role in health care fraud enforcement and strategies for avoiding qui tam suits. 

Sellers Prepare: Health Care Due Diligence

May 23, 2012 | Blog | By Karen Lovitch

Health care transactions present unique due diligence challenges. The buyer must evaluate the seller's compliance policies and procedures, arrangements with referral sources, patient and payor data, clinical data and compliance with federal and state licensure, certification and reimbursement regulations. 
Individuals who access protected health information without authorization may be found guilty of a misdemeanor even if they lack knowledge that their actions are illegal. 
ML Strategies has posted its weekly Health Care Reform Update.   This publication provides timely and concise information on  implementation of the Affordable Care Act, and other state and federal administrative and legislative activities related to health care reform.

HHS Officials Explain Risk Adjustment Methodology

May 15, 2012 | Blog | By Karen Lovitch

On May 7th and 8th, the Center for Consumer Information and Insurance Oversight (CCIIO) held a public meeting on risk adjustment, the process through which, under the Affordable Care Act (ACA), funds are transferred from health plans that attract relatively low-risk enrollees to plans that attract relatively high-risk enrollees, such as individuals with chronic health conditions.
ML Strategies has posted its weekly Health Care Reform Update.  This publication provides timely and concise information on  implementation of the Affordable Care Act, and other state and federal administrative and legislative activities related to health care reform.
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. 
ML Strategies has posted its weekly Health Care Reform Update.  This publication provides timely and concise information on  implementation of the Affordable Care Act, and other state and federal administrative and legislative activities related to health care reform.
Abbott Laboratories (Abbott), an Illinois company, will pay over $1.6 billion in penalties to the federal government and several states related to its alleged illegal promotion of the prescription drug Depakote for off-label uses, as announced by the settling parties on May 7, 2012. 

Press Coverage Triggers HIPAA-Related Inquiry

May 7, 2012 | Blog | By Karen Lovitch

Most state and federal health care investigations are prompted by audits or claims brought by whistleblowers. But a recent newspaper article about a debt collection company’s tactics has prompted Congressional ire and potentially a federal investigation. 
The Centers for Medicare & Medicaid Services Center for Consumer Information and Insurance Oversight (CCIIO) and the Internal Revenue Service (IRS) recently released four important documents related to the implementation of the Affordable Care Act (ACA) that address employer-provided health insurance plan reporting requirements and the availability of premium tax credits to individuals and families.The Centers for Medicare & Medicaid Services Center for Consumer Information and Insurance Oversight (CCIIO) and the Internal Revenue Service (IRS) recently released four important documents related to the implementation of the Affordable Care Act (ACA) that address employer-provided health insurance plan reporting requirements and the availability of premium tax credits to individuals and families.

Sunshine Act Implementation Delayed Until 2013

May 4, 2012 | Blog | By Brian Dunphy

With little fanfare, the Centers for Medicare & Medicaid Services (CMS) announced today on the CMS Blog that it is delaying data collection under the Sunshine Act until 2013. 
2012 is already a record-breaking year in health care fraud enforcement.  This week Attorney General Eric Holder and Secretary of the Department of Health and Human Services (HHS) Kathleen Sebelius announced the biggest takedown in the history of the Medicare Fraud Strike Force (Strike Force) in terms of Medicare dollars at stake.
Yesterday the Senate Finance Committee posted an open letter on its website to the health care sector soliciting industry stakeholder insights on ways to combat fraud, waste, and abuse in the Medicare and Medicaid programs.

OIG Advisory Opinion 12-05 Approves Consumer Rewards Program

May 2, 2012 | Blog | By Karen Lovitch, Theresa Carnegie

In OIG Advisory Opinion 12-05, the OIG found that a consumer rewards program (the “Program”) offered by a supermarket chain with in-store and independent pharmacies (the “Requestor”) would not be subject to enforcement under the Anti-Kickback Statute (the “Kickback Statute”) or the beneficiary inducement prohibition found in the civil monetary penalties law (the “CMP Law”).
ML Strategies has posted its weekly Health Care Reform Update.  This publication provides timely and concise information on  implementation of the Affordable Care Act, and other state and federal administrative and legislative activities related to health care reform

Massachusetts House Votes to Repeal Gift Ban Law

April 27, 2012 | Blog | By Brian Dunphy

Earlier this week the Massachusetts House of Representatives voted 128-22 to repeal the Massachusetts Pharmaceutical and Medical Device Manufacturer Code of Conduct (often called the “gift ban” law).
The Massachusetts Office of Consumer Affairs and Business Regulation received nearly 2000 data breach notifications affecting nearly 3.2 million individuals between October 31, 2007 and September 30, 2011, according to a report released on Monday. 
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