Articles Posted in Compliance

The U.S. Department of Justice (DOJ) and Rush University Medical Center agreed to settle a qui tam lawsuit alleging that Rush violated the Federal False Claims Act (FCA). The lawsuit, filed on July 12, 2004, alleged that Rush had violated the FCA by submitting certain false claims for payment to the Medicare and Medicaid programs. The DOJ intervened in the action and argued that Rush’s violation of the FCA occurred through the submission of claims for services referred by physicians with whom Rush had impermissible financial relationships. The alleged impermissible financial relationships were rent concessions on medical space leased to certain physicians. The government argued that these financial relationships were in violation of Stark Law and thus, Rush was prohibited from billing Medicare and Medicaid for services referred from those physicians. Pursuant to the settlement Rush will pay the federal government $1,547,200.00, and the relators will be awarded $270,760.00.

If you would like your financial relationship reviewed for Stark compliance or for more information, please visit www.wachler.com or contact a Wachler & Associates attorney at 248-544-0888.

On January 27, 2010, leaders of the American Dental Association (ADA), American Medical Association (AMA), American Osteopathic Association (AOA), and the American Veterinary Medical Association (AVMA) sent a letter to the Federal Trade Commission (FTC) Chairman Jon Leibovitz requesting that health professionals be excluded from the “Red Flags” Rule, a new regulation intended to combat identity theft.

The letter was prompted by a recent decision from the U.S. District Court for the District of Columbia involving a suit was brought by the American Bar Association (ABA) against the FTC. The court ruled that lawyers should be excluded from the requirements of the Red Flags Rule. The court stated that the application of the Red Flags Rule to attorneys “is both erroneous and inconsistent with the purpose underlying enactment of the [Fair and Accurate Credit Transactions Act of 2003 (FACT Act)].”

Similarly, the leaders of these health professional organizations called upon the FTC to exclude health professionals from the Red Flags Rule. The joint letter to the Chairman requests that the FTC take two actions: (1) announce that the Rule will not be applied against licensed healthcare professionals (LHCPs) until at least ninety days after final resolution of the ABA litigation; and (2) confirm that if the final resolution of the ABA litigation is that the Rule will not be applied to attorneys, the Rule will also not be applied to LHCPs.