Compliance News Roundup: Co-Pay Waivers

1. Federal prosecutors accuse local medical practice of fraud - “A local medical group that treats patients with cancer and blood disorders took illegal kickbacks and filed false Medicare claims, according to a complaint filed by federal prosecutors…Prosecutors allege two illegal schemes. In the first, the practice provided kickbacks to patients covered by Medicare by waiving those patients' copayments — typically about 20 percent of the cost, according to the complaint.” Read more here: http://www.poughkeepsiejournal.com/story/news/local/2016/10/20/medicare-fraud-hudson-valley-hematology/92475272/

2. New era of healthcare fraud investigations puts spotlight on the C-suite - “Traditionally, healthcare companies were only expected to provide information about the underlying factual situation in a fraud investigation. However, these investigations have become more complicated, as the Department of Justice has taken a strong stance on pursuing healthcare executives involved in fraud cases to hold them personally responsible.Venson Wallin, managing director of BDO's Healthcare Advisory practice, recently spoke with Becker's Hospital Review about the shift in individual accountability standards and steps hospital and health system executives can take to protect themselves from liability.” Read more here: http://www.beckershospitalreview.com/legal-regulatory-issues/new-era-of-healthcare-fraud-investigations-puts-spotlight-on-the-c-suite.html

3. One Often Forgotten Cause of Healthcare Fraud - “With an estimated 12% of Medicare and 10% of Medicaid payments lost to fraud and other improper payments in 2015, it is no surprise that battling healthcare fraud is a high priority on the government's checklist. In June of 2016, the Justice Department announced the largest healthcare fraud takedown in history with charges against 301 individuals totaling $900 million in false billing. Let's talk about one cause of healthcare fraud that doesn't get the limelight.” Read more here: http://www.hcplive.com/physicians-money-digest/contributor/future-proof-md/2016/10/one-often-forgotten-cause-of-healthcare-fraud#sthash.3vL6sOwQ.dpuf

4. $5.31 Million Civil Settlement with Hudson Valley Hematology-Oncology Associates for Waiving Patient Co-Payments: Deeper Than The Headlines: How Waiving Co-Payments Becomes Fraud - “On Friday, October 21, 2016 the U.S. Attorney in Manhattan announced a $5.31 million civil settlement with Hudson Valley Hematology-Oncology Associates in New York.  According to the court documents, Hudson Valley admitted to routinely waiving patient co-payments for Evaluation and Management (E/M) codes without an individualized determination of financial hardship or exhaustion of reasonable collection efforts.  The scheme revolved around routinely scheduled patient services such as injections, chemotherapy and venipunctures. In addition to these services, the practice would bill for the E/M services without documenting a significant and separately identifiable E/M service in addition to the routinely scheduled service.  As a way to avoid patient concerns, the practice would bill Medicare the E/M but waive the patient's’ financial responsibility.  Thus, the practice would be reimbursed for the E/M codes in addition to the routine services.” Read more here: Deeper Than the Headlines: Co-Pay Waivers