Tag: Anti-Kickback Statute
Florida man sentenced as part of $11M DME scheme
June 3, 2024HME News Staff
MIAMI – A Florida man has been sentenced to 96 months in federal prison, followed by three years of supervised release, after admitting his role in a multimillion-dollar DME kickback scheme and pleading guilty to carrying out a COVID-19 fraud scheme and being a felon in possession of firearms and ammunition. According to documents filed in the case and statements made in court, Kareem Memon of Coral Springs, Fla., and his conspirators owned and operated marketing call centers and telemedicine...
Man charged in $97M brace scheme
February 27, 2024HME News Staff
NEWARK, N.J. – A Florida man has been charged with an indictment unsealed on Feb. 21 for this role in a DME kickback scheme that caused $97 million in losses to Medicare, according to the U.S. Attorney’s Office of the District of New Jersey. Raheel Naviwala, 35, of Coral Springs, Fla., is charged in a 10-count indictment with one count of conspiracy to commit health care fraud and wire fraud, three counts of health care fraud, two counts of wire fraud, one count of conspiracy to violate...
CMS modernizes Stark Law
November 23, 2020HME News Staff
WASHINGTON - CMS has finalized a number of changes to the Stark Law, including new permanent exemptions for value-based arrangements, in a 627-page final rule set to be published in the Federal Register on Dec. 2.
The exemptions will allow physicians and other health care providers to design and enter into value-based arrangements without fear that legitimate activities to coordinate and improve the quality of care for patients and lower costs would violate the physician self-referral law,...
Relaxing the federal anti-kickback statute and Stark
February 3, 2020Guest Commentary
Historically, Medicare payments for health care have been based on the fee-for-service (FFS) model—that is, Medicare pays for the service regardless of the patient outcome. This model results in (i) providers not coordinating with each other and (ii) expenditure of money without evidence of tangible results. With 78 million baby boomers retiring at the rate of 10,000 per day, the FFS model is not sustainable. As such, Medicare is pushing providers away from the FFS model…and toward the...
HHS provides first look at proposed changes to Stark Law
October 10, 2019HME News Staff
WASHINGTON - The Department of Health and Human Services has proposed changes to the Stark Law that would, among other things, create new exceptions that recognize incentives are different in healthcare systems that pay for value- vs. volume-based care.The proposal includes proper safeguards that ensure the Stark Law will continue to provide meaningful protection against overutilization and other harms, while giving physicians and other healthcare providers added flexibility to improve the quality...
Lincare pays $5.25M to resolve allegations
August 21, 2018HME News Staff
CLEARWATER, Fla. - Lincare has paid $5.25 million to resolve allegations that it violated the federal False Claims Act and the Anti-Kickback Statute by offering illegal price reductions to Medicare beneficiaries, according to the U.S. Attorney's Office for the Southern District of Illinois. The government alleged that, from 2011 to 2017, Lincare attempted to gain a competitive advantage in the market by unlawfully waiving or reducing co-insurance, co-payments and deductibles for beneficiaries who...
Legal: Tread lightly with telehealth prescriptions
April 23, 2018Todd Moody
A. There is a good chance the prescription issued will not be valid, and the payment for the telehealth encounter could be problematic under an anti-kickback statute. In order for a prescribing practitioner, such as a physician, physician assistant, or nurse practitioner, to issue a valid prescription, the practitioner must first establish a practitioner-patient relationship. Most states now allow a practitioner to establish this relationship by way of a telehealth...
Legal: Mind the threshold
January 25, 2018Todd Moody
A. Yes, but the appropriate payment terms will depend on the nature of the leads.When reviewing any lead generation arrangement, a key regulatory issue is whether the arrangement complies with the federal Anti-Kickback Statute (AKS). The AKS prohibits a person from soliciting, receiving, offering, or paying anything of value in return for, or in order to induce referrals or the arrangement of referrals of individuals covered by a federal health care program (FHCP).In light of this, a threshold...
Respironics to pay $34.8M over re-supply program
March 23, 2016HME News Staff
MURRYSVILLE, Pa. - Philips Respironics has agreed to pay $34.8 million to resolve alleged False Claims Act violations for paying kickbacks to DME providers that bought its CPAP masks, the Department of Justice has announced.
The government alleges that from April 2012 to November 2015 Respironics waved the per-patient per-month fee for its medSage automated resupply services for DME providers that bought the company's masks. If they used a competitor's masks, the company charged a fee.
“The...
Legal: Comply with safe harbors
August 25, 2015Jill Vogel
A. During a recent Medicare conference, representatives of the Office of Inspector General announced that the healthcare industry should expect to see an uptick in the investigations of alleged Medicare fraud and abuse. True to their word, the OIG has been busy. As the new fiscal year approaches, now is a good time to review your agreements to confirm that they do not violate the federal anti-kickback statute (AKS) or applicable state laws.
Generally, the federal AKS prohibits suppliers and providers...