This is insight from Carolyn McNiven, a partner in DLA Piper’s Health Care Enforcement and Compliance Practice. The government’s intervention in a whistleblower’s federal False Claims Act case in Alabama(United States ex. Rel Dawn Richardson et al v. Golden Gate Ancillary LLC et al., 09 cv 627, ND Ala.) – which was recently made public … Continue Reading
Category Archives: Government Initiatives
Subscribe to Government Initiatives RSS FeedA Compliance Officer’s Wish List for 2012
Posted in Culture, Enforcement, Ethics, Government Initiatives, ReformI was visiting with some of my compliance colleagues recently and came up with an interesting Wish List for 2012: Additional resources. Clearer regulations :) Increased stakeholder support for compliance activities. More predictable and quicker voluntary disclosure processes. A better way to keep track of regulatory developments and new business arrangements. Acknowledgement by regulators and enforcers… Continue Reading
12 Enforcement and Compliance Predictions for 2012
Posted in Culture, DOJ, Enforcement, Government Initiatives, ICD, Implantable Cardiac Devices, Long Term Care, Medicaid, Medicare, OIG, Reform, SettlementsThis has been an interesting year for the health care industry, and I believe the coming year will be even more exhilarating. Here are my 12 enforcement and compliance predictions for 2012. Please comment with yours. We’ll see how we do. . . . Regardless of what happens with the health care reform law, the current market forces… Continue Reading
Medicaid RACs: Tool of transparency or torment?
Posted in Enforcement, Government Initiatives, Medicaid, RACsThe Medicaid RACs are coming soon, and prudent providers are getting ready for life in the formicarium (translated: ant farm). My colleage and blog co-editor, Rebecca Jones McKnight, wrote a clever and interesting Feature Focus in the December 2011 issue of the Health Care Compliance Association’s monthly publication, Compliance Today. She wonders whether CMS is… Continue Reading
Heads Up! HHS-OIG is Emphasizing Medicaid Enforcement
Posted in Enforcement, Government Initiatives, Medicaid, OIG, UncategorizedI have been saying for a while that there will be a renewed emphasis on Medicaid enforcement. Here’s some more objective evidence of this trend: The HHS-OIG has published Proposed Revisions of Performance Standards for State Medicaid Fraud Control Units. The current standards were promulgated in September 1994, in the aftermath of the last big health care… Continue Reading
The Government is Going After Health Care Execs
Posted in Culture, Enforcement, Government InitiativesI just returned from the HCCA/AHLA Fraud & Compliance Forum which was, as usual, a strong conference. One of the resounding themes was the government’s growing emphasis on holding health care executives and board members responsible for organizational non-compliance. The effort is no longer aimed solely at people who are associated with drug and device… Continue Reading
Medicaid RACs Will Soon Spring to Life: Another Head Grows on the Hydra of Government Oversight and Inquiry
Posted in Government Initiatives, Medicaid, RACs, ReformHere is a good summary of the new Medicaid RAC regulations. Thanks to my colleague Becca McKnight for putting it together. The original appears on DLA Piper’s Health Care Law Matters Blog. Contributed by Frank E. Sheeder III and Rebecca Jones McKnight as part of our ongoing Fraud & Abuse Matter series. Health care providers may… Continue Reading
Update: OIG’s Intensive Hospital Audits
Posted in Enforcement, Government Initiatives, OIGWe addressed the OIG’s ongoing intensive hospital audits in two previous posts: OIG Has New, Intensive Hospital Compliance Initiative, and More About OIG’s Intensive Hospital Audits — Required Reading. This post updates those discussions based on some recent audit reports. OIG has audited some new issues: Inpatient claims with same-day discharge and readmissions. Inpatient claims for 1-day… Continue Reading
HHS Redoubles its Data Prospecting Efforts
Posted in CMS, Enforcement, False Claims Act, Government Initiatives, ICD, Implantable Cardiac Devices, Medicare, OIG, ReformIn previous posts, I have mentioned the government’s “data prospecting” efforts, and highlighted the difference between “data mining” and “data prospecting.” Mining is done when you already know where to dig. Prospecting, which is what the government has been doing, involves finding out where to dig. There’s a big difference, and the implications should not… Continue Reading
View the OIG HEAT Provider Compliance Training Webcast
Posted in Administration, Enforcement, False Claims Act, Fraud, Government Initiatives, Medicaid, Medicare, OIG, ReformOIG has posted a webcast of its HEAT Provider Compliance Training. It is 3 hours, 45 minutes long. I will post a summary in the near future. There is also an OIG HEAT Provider Compliance Training Website at which you can download the corresponding slides and related materials. Get Instant Updates by Email
Frank Sheeder
Frank Sheeder, chair of DLA Piper's Health Care Enforcement and Compliance practice, has defended clients against civil and criminal fraud allegations brought by the government and other hostile third-party litigants – especially whistleblowers – for more than 20 years... Read More