Category Archives: Fraud and Abuse

2016 Hot Compliance Areas For Physician Practices

Physician practices should pay attention to the recent reports released by the Department of Justice (DOJ), OIG and other agencies regarding their enforcement actions in 2015 and priorities in 2016. These reports and recent settlements reveal hot compliance areas that physician practices should focus on in 2016.

The following are some of the hot compliance areas in 2016 for physician practices based on recent reports such as the DOJ Health Care Fraud and Abuse Control Program Annual Report for 2015 and settlements and other enforcement actions involving physicians. Continue reading

A Broader Definition of “Referral” for Anti-Kickback Violations

In U.S. v. Patel, whether a violation of the Anti-Kickback Statute was present depended on the United States Court of Appeals for the Seventh Circuit’s interpretation of the term “referring,” a term not specifically defined in the statute.  2015 WL 527549 (7th Cir. 2/10/15). The Seventh Circuit considered whether Dr. Kamal Patel had “referred” patients to a home health care provider in violation of the Anti-Kickback statute when Dr. Patel signed Form 485 certifications and recertifications for his patients, though did not recommend a specific home health care provider, in exchange for cash. Continue reading