The False Claims Act (“FCA”) is an ever-present concern among health care providers and counsel, which is why it is no surprise that the Department of Health and Human Services’ (HHS) recent “Regulatory Sprint to Coordinated Care” may impact FCA enforcement trends. Dorsey’s Health Law Blog team has been closely monitoring the “Regulatory Sprint,” including the sweeping set of proposed regulations issued by the HHS...
The Centers for Medicare and Medicaid Services (“CMS”) issued new Self-Referral Disclosure Protocol (“SRDP”) forms, and, beginning June 1, 2017, these SRDP forms will be mandatory for those parties submitting voluntary self-disclosures of actual or potential violations of the federal physician self-referral law (the “Stark Law”) through the SRDP. The Patient Protection and Affordable Care Act established the SRDP, giving providers and suppliers that may...
In the most recent example of its continued effort to hold individuals accountable for corporate misconduct, the U.S. Department of Justice (“DOJ”) announced on September 27, 2016, that the former CEO of Tuomey Healthcare System has agreed to pay $1 million to settle claims arising from his involvement in the hospital’s violations of the Stark Law. In addition to the $1 million civil fine, the...
At a July 12, 2016 hearing entitled “Examining the Stark Law: Current Issues and Opportunities,” members of the U.S. Senate Finance Committee expressed openness to potentially significant amendments to the Stark Law aimed at alleviating the threat of potentially devastating liability the Stark Law can impose on health care providers that pursue value-based payment models. The Stark Law, 42 U.S.C. § 1395nn, generally prohibits a...
In a recent opinion, the Northern District of California allowed FCA claims to proceed against the CEO of a skilled nursing facility operator. John Orten, the whistleblower in the suit, was a former nursing home administrator for North American Health Care, Inc. (NAHC). Orten claimed that he had witnessed the CEO of NAHC, John Sorensen, order company administrators to pay physicians who referred patients to...
The Department of Justice and Tuomey Healthcare have announced a $72.4 million settlement in a lawsuit that the DOJ touts as “another achievement for the [DOJ and DHS] Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative.” The settlement follows a 2013 trial in which a jury found Tuomey had violated the False Claims Act and Stark Law by filing more than 21,000 false...
On July 2, the U.S. Court of Appeals for the Fourth Circuit affirmed a jury verdict of more than $237 million against Tuomey Healthcare System, a nonprofit hospital in South Carolina, based on Stark Law and False Claims Act violations. United States ex rel. Drakeford v. Tuomey Healthcare System, No. 13-2219 (4th Cir. July 2, 2015). The Government’s claims in the case were based on...
