Genetic Testing Scams on OIG Radar

genetic testing scam OIG
genetic testing scam OIG

By: Jacqueline Bain

On June 3, 2019, the Department of Health and Human Services Office of the Inspector General (the “OIG”) issued a Fraud Alert titled: Genetic Testing Scam. Though the alert is short, the fact that the alert itself was issued is important. The OIG doesn’t often issue fraud alerts, so taking an affirmative step like this shows an increased likelihood of regulatory action.

Physicians, take note. If you are working with a laboratory providing genetic testing services, be sure that laboratory is (1) running those specimens on its own equipment; (2) only sending out testing equipment after receiving your order; and (3) has in place policies and procedures designed to accurately bill for the services it performs and other compliance matters.

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Florida Telehealth Law Basics

By: Dave Davidson

florida telehealth law

The opportunities to use technology to provide healthcare services seem to be growing as fast as technology itself.  This is especially true in the area of care being provided by a “remote” provider.  In fact, an AMA study released in May 2019 indicated that telehealth was the fastest growing “place of care” in the country, outpacing urgent care centers, retail clinics, and ambulatory surgery centers.  Unfortunately, the laws governing telehealth have not always kept up with the pace of that growth, and questions remained about how it could be provided in Florida.  However, the Florida legislature did something about that this year, by passing House Bill 23, which Governor Ron DeSantis signed into law on June 25, 2019.  The act, which is primarily codified in Florida Statutes §456.47, took effect on July 1, 2019 and answers many outstanding questions.  These questions are addressed below.

What Constitutes Telehealth in Florida and Who can Practice It?

The new law sets out a straightforward, and broad, definition of telehealth.  Basically, telehealth in Florida is the use of telecommunication technology by a telehealth provider to provide healthcare services.  These services can include assessment, diagnosis, consultation, treatment, monitoring, transfer of medical data, education, public health services and health administration.  Voice-only telephone calls, emails and faxes are specifically excluded from the definition.  Obviously those activities are still permissible, but they fall outside the definition. 

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The Impact of Healthcare Fraud: Beyond Financial

HHS Stimulus Payment action required on Second Round

By: Richard A. Merlino, Guest Contributor

healthcare fraud

Healthcare fraud abuse comes in a variety of shapes and sizes, ranging from the simple filing of a false Medicare claim to grand schemes arranging kickbacks (i.e., payment by one party to another for having referred business or otherwise produced income for the payer). Similarly, the typical conception of “culpability” for the commission of healthcare related criminal acts varies dramatically across a variety of Federal criminal statutes enacted to protect against fraud.

For instance, one may be criminally liable under the Federal Anti-Kickback provisions for receiving benefits “directly or indirectly”, “overtly or covertly”, and “in cash or in kind”. Accordingly, although knowledge of receipt of benefit is a necessary element, the Government may seek a conviction even where “indirect” “non-cash” benefits are received. Along the same lines, Federal healthcare laws are comprised of more than merely criminal statutes, which provide a harsh deterrent to fraud and ensure legal compliance. Federal law also provides a complex framework of civil protection (under statutes such as the False Claims Act) and administrative penalties (such as suspension of licensure) to supplement the criminal provisions effecting healthcare fraud and administration.

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