Bloomberg BNA recently published a Health Care Fraud Report entitled Outlook 2015: Uptick Expected in Stark, Anti-Kickback FCA Cases, Self-Disclosures, which examines the top issues for health care providers and suppliers to watch in 2015.
My colleagues Tom Crane and Larry Freedman were quoted extensively in the article, and they discussed a broad range of health care fraud and abuse issues to watch, including the:
- Continuing growth of provider self-disclosures to the Centers for Medicare & Medicaid Services (“CMS”) and the Office of Inspector General (“OIG”);
- Possible collateral uses by relators of the information about financial relationships between drug and device manufacturers and physicians and teaching hospitals disclosed as part of CMS’s Open Payments program (i.e., the “Sunshine Act”);
- Proposed new safe harbors to the Anti-kickback Statute and the so-called “gainsharing” Civil Monetary Penalties Law;
- Use of statistical sampling as evidence of a wider scope of false claims to prove liability in litigation under the False Claims Act (“FCA”);
- Increasing focus by the Department of Justice and relators on FCA claims based upon physician compensation arrangements with hospitals, including potential Stark Law violations;
- Continuing questions about the viability of a “worthless services” theory of liability under the FCA; and
- Recovery Audit Contractor program changes.