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Anti-Kickback Statute vs. Stark Law

Physicians and health care professionals should be familiar with and know the distinctions between the Anti-Kickback Statute (AKS) and Stark Law. These laws apply to doctors receiving compensation for inappropriate referrals.  Understanding the differences between the two can avoid potential problems for physicians and their practices. Anti-Kickback Statute: The Basics AKS is a federal health […]

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Hospital Doctors Face Non-Compete Agreements

Many physicians have left private practices to work at hospitals, and there are several reasons for this migration. The Affordable Care Act (ACA) changed the landscape for healthcare, and certain doctors feel that the regulations can be a burden. David Chan, MD from UCLA, Stanford Oncology Fellowship, states that the only way to be compliant with […]

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Possible Changes to Drug Kickback Laws

At the annual Food and Drug Administration conference, Commissioner Scott Gottlieb suggested the federal laws that protect rebates circulated between pharmacy benefit managers, insurance companies, and drug manufacturers are due for a change. He offered that drug rebates currently protected by the federal government are partly to blame for rising medication costs and revamping the […]

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Opioid Kickbacks May Be Fueling Epidemic

Recently, the Department of Justice (DOJ) has intervened in five anti-kickback lawsuits against Insys Therapeutics, Inc. (Insys), the manufacturer of Fentanyl. In 2012, Insys received approval from the Food and Drug Administration (FDA) for Fentanyl to treat persistent breakthrough pain in adult cancer patients who developed tolerance toward around-the-clock opioid therapy. It is a spray […]

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Health Care Professionals Pursue Whistleblower Litigation

Qui tam litigation can be a complex and exhausting process. If the case is not settled and must go to trial, it can take even longer to reach a resolution. In a case that dates to 2015, United States of America, et al v. BlueWave Healthcare Consultants, Inc., et al. has yet to be fully […]

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Ridesharing Rivals Anti-Kickback Laws

An increasing number of patients are missing doctor appointments, blood draws, X-ray appointments, and other routine non-emergency testing due to lack of transportation. Statistics show that over three million patients each year will miss a medical appointment because of transportation issues. Many patients in rural areas have limited access to transportation for non-emergency medical appointments. […]

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Changes in the Stark Law

Many physicians are familiar with Stark Law, which prohibits a physician from referring a Medicaid or Medicare patient to a health care entity where the physician or their family has a financial interest. With a goal of reducing healthcare fraud and abuse, the law sets forth technical compliance requirements. Also known as the Physician Self-Referral […]

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Pennsylvania’s Medical Marijuana Law Presents Challenges to Physicians

In 2016, Pennsylvania passed Act 16, which legalized the use of medical marijuana in the state. Under Act 16, the Pennsylvania Department of Health (DOH) has the authority to issue licenses to those that grow medical marijuana and operators of medical marijuana dispensaries. Pennsylvania’s Medical Marijuana Program To participate in Pennsylvania’s Medical Marijuana Program, patients […]

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Charitable Donations Do Not Result in Liability Under False Claims Act

The U.S. Court of Appeals for the Third Circuit recently held that charitable donations found in violation of anti-kickback statutes do not necessarily provide the grounds for liability under the False Claims Act (FCA). According to the ruling, without additional evidence that the alleged kickback was tied to a specific claim for payment, violators of […]

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Kmart Pays $32 Million for Overbilling Federal Health Programs

National retail giant, Kmart Corporation, recently agreed to pay the United States $32.3 million to settle allegations that in-store pharmacies overcharged federally-funded health care programs for generic drugs. The settlement stems from a 2008 False Claims Act lawsuit filed by an Ohio pharmacist, who stands to receive more than $9 million for his portion of […]

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