Check out Health Law Expressions -- our podcast channel, in which HortySpringer attorneys give their take on cutting edge developments in health law in 20 minutes or less, and have some fun while doing so. You give us 20 minutes, we’ll give you the law.
On this episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar look at what happens when an OIG Advisory Opinion on pharmaceutical subsidies turns into a court battle over the language of the Anti-Kickback Statute. Listen now to this episode of The Kickback Chronicles to see what you can learn from the misfortune of others.
HortySpringer attorneys Henry Casale and Hala Mouzaffar review how the “But For” test is changing the landscape of false claims cases brought in qui tam lawsuits. Listen now to this episode of The Kickback Chronicles to see what you can learn from the misfortune of others.
On this week’s episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar dive into a case of alleged bribery to induce providers to prescribe a specific pharmaceutical drug that resulted in a new test for Anti-Kickback claims in the Second Circuit. Listen now to this episode of the “Kickback Chronicles” to see what you can learn from the misfortune of others.
In this episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar change gears and discuss how a surgery center could have prevented disaster with its credentialing and peer review processes.
Unless you have been in a coma or hiding in the Witness Protection Program, you probably are aware that there is an election coming up in a few weeks. It is our right as Americans to vote and participate in the political process. But nonprofit organizations like hospitals and health systems that are tax exempt under Section 501(c)(3) of the Internal Revenue Code are prohibited from participating in political campaigns and may only have limited involvement in lobbying or attempting to influence p...
Exciting news for those in the PSO world! The United States Court of Appeals for the Eleventh Circuit issued an opinion (In re Baycare Medical Group , 101 F.4th 1287 (11th Cir. 2024)) on May 14, 2024 that expands the scope of information, known as “Patient Safety Work Product,” protected by the Patient Safety and Quality Improvement Act (“PSQIA”). The Court rejects the “sole purpose” test articulated by other courts and the Department of Health and Human Services (“HHS”), finding that the test a...
HortySpringer attorneys Henry Casale and Hala Mouzaffar take a look at three clinics in rural Alabama to see how a physician’s disregard of warnings that her clinics were committing fraud led to the fall of the clinics, the physician, and the physician’s wife. Listen now to this episode of the The Kickback Chronicles to see what you can learn from the misfortune of others.
On this week’s episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar dive into the case of a seasoned professional who found himself in the middle of not one, not two, but three different fraudulent healthcare schemes. Listen now to this episode of the “Kickback Chronicles” to see what you can learn from the misfortune of others.
It has been a longstanding practice within Hospitals across the U.S. for medical students and other practitioners-in-training to perform pelvic and other sensitive examinations on patients, most of whom are under anesthesia, without their explicit consent. Join Hala and Mary as they discuss the growing movement to better police this practice and how, as a result of mounting public scrutiny, it has caught the attention of CMS.
On this week’s episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar take a look at how some not-so-routine drug testing landed two providers in hot water. Listen now to this episode of the “Kickback Chronicles” to see what you can learn from the misfortune of others.
When hospitals and health systems are pursuing a merger or affiliation, there is a natural tendency to move things along quickly. While it is ok to conduct due diligence, explore potential efficiencies and plan for what might be possible if the affiliation takes place, the parties need to refrain from acting like they are already affiliated, implementing plans or sharing competitively sensitive information such as payor contracts until the deal is done. To do so could constitute unlawful “gun ju...
On this week’s episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar turn their attention to a small town in Tennessee to look at a provider that helped exacerbate the opioid crisis in his community for fame and fortune. Listen now to this episode of the “Kickback Chronicles” to see what you can learn from the misfortune of others.
Two recent lawsuits decided by Utah courts draw attention to the importance of strong, broad release language protecting physician leaders who volunteer to participate in credentialing, peer review, and other medical staff activities. In both cases, the physicians challenging peer review activity argued that the release language set forth in the Medical Staff Bylaws should not be applied to block their claims. One aggrieved physician claimed that the release language only applied to formal revie...
On this week’s episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar take their first look at for-profit hospitals to discuss a unique case involving a hospital, its investors, and an attempt to avoid repaying Medicare. Listen now to this episode of The Kickback Chronicles to see what you can learn from the misfortune of others.
CMS recently clarified that physicians can give orders via test in hospitals and critical access hospitals. But the texts have to be through a secure system, and computerized physician order entry is still preferred. Join HortySpringer attorneys Dan Mulholland and Mary Paterni as they discuss this new CMS guidance and also talk about the dangers of texting in general.
On this episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar take a look at cases happening in their own backyard to show that healthcare fraud can happen anywhere. Listen now to this episode of the “Kickback Chronicles” to see what you can learn from the misfortune of others.
The Office of Inspector General recently published its General Compliance Program Guidance. The GCPG is a reference guide for the health care compliance community and other health care stakeholders. It is chock-full of information about relevant Federal laws, compliance program infrastructure, OIG resources, and other information useful to understanding health care compliance. While the GCPG is voluntary guidance and not binding on any individual or entity, it is an important roadmap to how the ...
On this week’s episode of The Kickback Chronicles, HortySpringer attorneys Henry Casale and Hala Mouzaffar look back at cases they have discussed over the last year to see where the defendants are today, what sentences they actually received, and if any old habits die hard. Listen now to this episode to see what you can learn from the misfortune of others.
On this week’s episode of The Kickback Chronicles, HortySpringer attorneys Henry Casale and Hala Mouzaffar discuss a series of fraudulent schemes that spanned the West Coast. They take a deeper dive into how “one of the nation’s busiest” physicians got caught in a scheme riddled with fraud and abuse. Listen now to see what you can learn from the misfortune of others.
In the Congressional Appropriations Act passed in December 2022, Congress adopted a new Stark exception and Anti-Kickback safe harbor for wellness programs for physicians and other clinicians. Specifically, the new law provides that counseling, mental health services, suicide and substance abuse prevention programs offered by hospitals and other providers with a formal medical staff will not violate the Stark law or Anti-Kickback Statute so long as the are set out in a board-approved policy that...
The Kickback Chronicles, Episode 18 On this week’s episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar discuss what happens when a Chief Compliance Officer stops performing in accordance with his job description and instead becomes the center of a fraudulent scheme. Listen now to this episode of The Kickback Chronicles to see what you can learn from the misfortune of others.
The U.S. Supreme Court recently held that in order to violate the False Claims Act, a defendant’s knowledge and subjective beliefs matter—not to what an objectively reasonable person may have known or believed. That case – U.S. ex rel Schutte v. Supervalu, Inc. – dispels the notion that defendants can skate on an FCA claims by coming up with after-the-fact justifications. Understanding this case and its implications is a must for any compliance officer or in house or external counsel in the heal...
The Kickback Chronicles, Episode 17 On this week’s episode of The Kickback Chronicles, HortySpringer attorneys Henry Casale and Hala Mouzaffar examine a pharmacogenetic testing scheme spanning several states and take a closer look at the spider web of arrangements that frauded Medicare out of $28 million. Listen now to this episode of The Kickback Chronicles to see what you can learn from the misfortune of others.
The Kickback Chronicles, Episode 16 On this week’s episode of The Kickback Chronicles, HortySpringer attorneys Henry Casale and Hala Mouzaffar examine one of their favorite archetypes: the repeat offender. They examine how a former PA already convicted for practicing without a license re-emerged years later to repeat her crimes. Listen now to this episode of The Kickback Chronicles to see what you can learn from the misfortune of others.
The Kickback Chronicles, Episode 15 On this week’s episode of The Kickback Chronicles, HortySpringer attorneys Henry Casale and Hala Mouzaffar examine a massive scheme involving a compound pharmacy and TRICARE. They take an especially close look at the lengths this group went to after they were caught to cover their trail and falsify documents—all in a fruitless effort to vindicate themselves of any wrongdoing. Listen now to this episode to see what you can learn from the misfortune of others....
The Kickback Chronicles, Episode 14 On this week’s episode of The Kickback Chronicles, HortySpringer attorneys Henry Casale and Hala Mouzaffar examine a scheme involving ophthalmology surgery equipment. In a scheme seemingly drenched in kickbacks, find out why the company and its owner decided to roll the dice and take their case to trial.
The Kickback Chronicles, Episode 13 On this week’s episode of The Kickback Chronicles series, HortySpringer attorneys Henry Casale and Hala Mouzaffar see how encompassing pharmaceutical fraud can be by taking a closer look at three recent cases, each involving prescriptions, each entirely unique from the others, and each more expensive than the last. Listen now to this episode of the “Kickback Chronicles” to see what you can learn from the misfortune of others.
The Kickback Chronicles, Episode 12 On this week’s episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar look at a North Carolina Medicaid fraud scheme in which Medicaid recipients were required to submit medical unnecessary urine specimens that were billed to the North Carolina Medicaid program in order to participate in subsidized housing programs, after school programs, and mental health and other clinics. Listen now to this episode of the “Kickback Chronicles” to see what you can ...
The Kickback Chronicles, Episode 11 On this week’s episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar review the recent sentencing of two individuals connected with over prescribing Subsys, one of the drugs at the center of the opioid crisis. Listen now to this episode of the “Kickback Chronicles” to see what you can learn from the misfortune of others.
The Joint Commission announced in mid-December that, effective immediately, hospitals could begin reappointing and renewing clinical privileges for practitioners every three years, rather than every two years. This is nothing new for those hospitals accredited by the DNV, but with this announcement, many hospitals accredited by TJC are considering moving to a three-year appointment period. Before making this decision, there are several factors that you should evaluate. For example, what changes ...
