The safe harbors do not cover every area of permissible behavior, and an arrangement may not qualify as a safe harbor, but still not subject someone to the risk of prosecution.
In fact, the courts have interpreted the Federal Anti-Kickback Law relatively narrowly. The court in Feldstein v. Nash Community Health Servs., 51 F. Supp.2d 673 (E.D.N.C. 1999), implied that the government has to show that a defendant knowingly intended to violate the anti-kickback law. However, the court did not go so far as to permit ignorance of the law to form a defense to the charge; on the contrary, the court expected the health-care providers to know the content of fraud alerts issued by the regulatory agency. The Feldstein court was building on earlier similar decisions in Hanlester Network v. Shalala, 51 F.3d 1390 (9th Cir. 1995) and United States v. Bay State Ambulance & Hosp. Rental Serv. Inc., 874 F.2d 20 (1st Cir. 1989).
The Office of Inspector General (OIG) of the U.S. Department of Health is in charge of enforcing the Federal Anti-Kickback Law. The OIG has developed regulations to help ensure compliance with the Law, but is also aware that many contemplated arrangements may not fall within the safe harbors, but still would not violate the Law. Therefore, the OIG will provide advisory opinions about specific proposed business arrangements. Moreover, while these opinions cannot be used as legal precedent, the OIG does publish the opinions, to help provide guidance to people in determining whether a specific arrangement...
Medicare and Medicaid Services (CMS), previously the Health Care Financing Administration (HCFA), that by the time 2011, health care expenditure will arrive at $2.8 trillion, as well as it will bill for 17% of the Gross Domestic Product. As a result, it is no revelation that white-collar offenders observe health care deception as a rewarding effort. Certainly, the General Accounting Office ("GAO") quotes that such deception accounts for up
Furthermore, we cannot forge a safe harbor under 42 C.F.R. §1001.952(p), because Sundown Community Hospital is not a physician's group (Altshuler, Creekpaum, & Fang, 2008). Finally, the proposed arrangement does not fall within the safe harbor provided for investments in group practice because the hospital would not meet the criteria of: equity interests held by licensed professionals; equity interests being in the entire practice; unified business with unified decision
Amerigroup Illinois Inc. Fraud CaseAmerigroup Illinois Inc. was found guilty in 2006 under the Federal Claims Act and the Illinois Protection Act. Amerigroup and its subsidiaries denied enrolling pregnant women and unhealthy patients in its managed care program in Illinois. Amerigroup received payment from the state and federal governments to operate a Medicaid health care program for low-income earners (Department Justice, 2008). Amerigroup was mandated by law to enroll all
Insurance Fraud After tax evasion, insurance fraud is considered the highest-ranked among white-collar crimes. The original concept of insurance, as a for-profit endeavor, was to collect funds from a large number of people to pay for damages and accidents that involved a small percentage of the population that paid premiums. Insurance fraud is an ever-growing problem. Solving or eliminating this problem requires the resources and knowledge of individuals or associations with
Through its partnership with the Department of Justice and the Human Health Services, the HEAT has expanded data sharing and improved information sharing procedures in order to get critical data and information into the hands of law enforcement agencies to enable them track patterns of fraud and abuse, and increase efficiency in investigating and prosecuting complex health care frauds (Department of Health and Human Services, HHS, 2011). The DOJ
Care Technology and Ethical Concerns Complete APA Reference Fed'n of State Med. (2014, April 26). State Medical Board's Appropriate Regulation of Telemedicine (SMART) Workgroup, Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine. Retrieved from www.fsmb.org/pdf/FSMB_Telemedicine_Policy.pdf Briefly description of the project Under telemedicine, one gets multiple practice spheres for healthcare lawyers, including reimbursement, payment, abuse and fraud, privileging and credentialing, privacy, peer view, licensing, as well as regulatory compliance.
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