Bloomberg BNA Publishes Outlook for Health Care Fraud in 2016

Bloomberg BNA has published its Outlook for Health Care Fraud for 2016, which includes information gathered from interviews with health care attorneys, trade association executives and health care consultants and recommendations on what health care providers can do to protect themselves.

The report focuses on the following health care fraud trends:

False Claims Act litigation — more cases will be filed in 2016, particularly those that include a Stark law violation.  Stark prohibits doctors from referring Medicare patients to entities with which they or a member of their family have a relationship.

Individual enforcement — the federal government will continue to push for the prosecution of individuals per a Department of Justice policy memo in 2015 that said prosecutors must focus on individuals from the beginning of any investigation.  With this new policy now in place, organizations will also need a stronger plan for conducting investigations of potential wrongdoing.

Medicare 60-Day rule — the anticipated release of the final Medicare 60-day rule, which requires a provider to return Medicare overpayments to the agency within 60 days, may lead to a flood of self-disclosures from providers.  The final rule is anticipated to include a six-year look-back period.

In addition, other top issues for 2016 include:

  • Release of new regulations revising fraud and abuse laws.
  • Increased enforcement of civil monetary penalties.
  • Focus on specialty pharmacy fraud.
  • Aligning alternate payment models with the Stark law and the anti-kickback statute.
  • Use of statistical sampling to support FCA cases.
  • Kickbacks to pharmaceutical and medical device manufacturers.
  • Attention on defective medical devices.

Whether you are facing a serious federal white-collar prosecution, a state murder charge, or misdemeanor charges, The Cogdell Law Firm has the experience, knowledge and reputation you want for your legal team. When results matter most, contact Dan Cogdell at 713-426-2244 or dan@cogdell-law.com.

We solve problems other lawyers can't. It's what we do.

Join Our Email List

    By checking this box, I agree to give Pride Houston permission to send promotional and information emails to my address.
“The intensity of your focus and preparation is nothing short of incredible. Your grasp of detail and nuance in complex transactions prove intellectual skills worthy of any adversary. Your “in your face” trial skills held the courtroom’s attention at every word and act, and blunted the government’s attacks at every assault. Not a day passed that I was not thankful and proud that I chose you to defend me.”

L. R.