On this week’s episode of The Kickback Chronicles, HortySpringer attorneys Henry Casale and Hala Mouzaffar discuss a series of fraudulent schemes that spanned the West Coast. They take a deeper dive into how “one of the nation’s busiest” physicians got caught in a scheme riddled with fraud and abuse.  Listen now to see what you can learn from the misfortune of others.

On this week’s episode of The Kickback Chronicles, HortySpringer attorneys Henry Casale and Hala Mouzaffar discuss a series of fraudulent schemes that spanned the West Coast. They take a deeper dive into how “one of the nation’s busiest” physicians got caught in a scheme riddled with fraud and abuse.  Listen now to see what you can learn from the misfortune of others.

Fraud Will Cost You Your Yellow Submarine

In the Congressional Appropriations Act passed in December 2022, Congress adopted a new Stark exception and Anti-Kickback safe harbor for wellness programs for physicians and other clinicians. Specifically, the new law provides that counseling, mental health services, suicide and substance abuse prevention programs offered by hospitals and other providers with a formal medical staff will not violate the Stark law or Anti-Kickback Statute so long as the are set out in a board-approved policy that meets five specific elements described in the statute.Join HortySpringer Partners Henry Casale and Dan Mulholland on this new Health Law Expressions podcast episode as they explain the new law and what you should do to take advantage of it.  

In the Congressional Appropriations Act passed in December 2022, Congress adopted a new Stark exception and Anti-Kickback safe harbor for wellness programs for physicians and other clinicians. Specifically, the new law provides that counseling, mental health services, suicide and substance abuse prevention programs offered by hospitals and other providers with a formal medical staff will not violate the Stark law or Anti-Kickback Statute so long as the are set out in a board-approved policy that meets five specific elements described in the statute. Join HortySpringer Partners Henry Casale and Dan Mulholland on this new Health Law Expressions podcast episode as they explain the new law and what you should do to take advantage of it.

Don’t Get Burnout from Your Wellness Program: The New Stark Exception and Anti-Kickback Safe Harbor for Wellness Programs

The Kickback Chronicles, Episode 18On this week’s episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar discuss what happens when a Chief Compliance Officer stops performing in accordance with his job description and instead becomes the center of a fraudulent scheme.  Listen now to this episode of The Kickback Chronicles to see what you can learn from the misfortune of others.

The Kickback Chronicles, Episode 18 On this week’s episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar discuss what happens when a Chief Compliance Officer stops performing in accordance with his job description and instead becomes the center of a fraudulent scheme.  Listen now to this episode of The Kickback Chronicles to see what you can learn from the misfortune of others.

Fox in the Hen House a/k/a Compliance Officer Goes Rogue

The U.S. Supreme Court recently held that in order to violate the False Claims Act,  a defendant’s knowledge and subjective beliefs matter—not to what an objectively reasonable person may have known or believed.  That case – U.S. ex rel Schutte v. Supervalu, Inc. – dispels the notion that defendants can skate on an FCA claims by coming up with after-the-fact justifications.  Understanding this case and its implications is a must for any compliance officer or in house or external counsel in the health care field.  Join HortySpringer partners Henry Casale and Dan Mulholland as they explain this case and what it will mean for health care providers in this new podcast episode.   

The U.S. Supreme Court recently held that in order to violate the False Claims Act,  a defendant’s knowledge and subjective beliefs matter—not to what an objectively reasonable person may have known or believed.  That case – U.S. ex rel Schutte v. Supervalu, Inc. – dispels the notion that defendants can skate on an FCA claims by coming up with after-the-fact justifications.  Understanding this case and its implications is a must for any compliance officer or in house or external counsel in the health care field.   Join HortySpringer partners Henry Casale and Dan Mulholland as they explain this case and what it will mean for health care providers in this new podcast episode.

What You Know Will Hurt You

 The Kickback Chronicles, Episode 17On this week’s episode of The Kickback Chronicles, HortySpringer attorneys Henry Casale and Hala Mouzaffar examine a pharmacogenetic testing scheme spanning several states and take a closer look at the spider web of arrangements that frauded Medicare out of $28 million.  Listen now to this episode of The Kickback Chronicles to see what you can learn from the misfortune of others.

The Kickback Chronicles, Episode 17 On this week’s episode of The Kickback Chronicles, HortySpringer attorneys Henry Casale and Hala Mouzaffar examine a pharmacogenetic testing scheme spanning several states and take a closer look at the spider web of arrangements that frauded Medicare out of $28 million.  Listen now to this episode of The Kickback Chronicles to see what you can learn from the misfortune of others.

Testing Positive for Fraud

 The Kickback Chronicles, Episode 16On this week’s episode of The Kickback Chronicles, HortySpringer attorneys Henry Casale and Hala Mouzaffar examine one of their favorite archetypes: the repeat offender. They examine how a former PA already convicted for practicing without a license re-emerged years later to repeat her crimes.  Listen now to this episode of The Kickback Chronicles to see what you can learn from the misfortune of others.

The Kickback Chronicles, Episode 16 On this week’s episode of The Kickback Chronicles, HortySpringer attorneys Henry Casale and Hala Mouzaffar examine one of their favorite archetypes: the repeat offender. They examine how a former PA already convicted for practicing without a license re-emerged years later to repeat her crimes.  Listen now to this episode of The Kickback Chronicles to see what you can learn from the misfortune of others.

Catch Me If You Can—Health Care Edition

 The Kickback Chronicles, Episode 15On this week’s episode of The Kickback Chronicles, HortySpringer attorneys Henry Casale and Hala Mouzaffar examine a massive scheme involving a compound pharmacy and TRICARE. They take an especially close look at the lengths this group went to after they were caught to cover their trail and falsify documents—all in a fruitless effort to vindicate themselves of any wrongdoing.  Listen now to this episode to see what you can learn from the misfortune of others.

The Kickback Chronicles, Episode 15 On this week’s episode of The Kickback Chronicles, HortySpringer attorneys Henry Casale and Hala Mouzaffar examine a massive scheme involving a compound pharmacy and TRICARE. They take an especially close look at the lengths this group went to after they were caught to cover their trail and falsify documents—all in a fruitless effort to vindicate themselves of any wrongdoing.  Listen now to this episode to see what you can learn from the misfortune of others.

Master of Disguise

 The Kickback Chronicles, Episode 14On this week’s episode of The Kickback Chronicles, HortySpringer attorneys Henry Casale and Hala Mouzaffar examine a scheme involving ophthalmology surgery equipment. In a scheme seemingly drenched in kickbacks, find out why the company and its owner decided to roll the dice and take their case to trial.  

The Kickback Chronicles, Episode 14 On this week’s episode of The Kickback Chronicles, HortySpringer attorneys Henry Casale and Hala Mouzaffar examine a scheme involving ophthalmology surgery equipment. In a scheme seemingly drenched in kickbacks, find out why the company and its owner decided to roll the dice and take their case to trial.

Friendship is in the Eye of the Beholder

 The Kickback Chronicles, Episode 13On this week’s episode of The Kickback Chronicles series, HortySpringer attorneys Henry Casale and Hala Mouzaffar see how encompassing pharmaceutical fraud can be by taking a closer look at three recent cases, each involving prescriptions, each entirely unique from the others, and each more expensive than the last.  Listen now to this episode of the “Kickback Chronicles” to see what you can learn from the misfortune of others.

The Kickback Chronicles, Episode 13 On this week’s episode of The Kickback Chronicles series, HortySpringer attorneys Henry Casale and Hala Mouzaffar see how encompassing pharmaceutical fraud can be by taking a closer look at three recent cases, each involving prescriptions, each entirely unique from the others, and each more expensive than the last.  Listen now to this episode of the “Kickback Chronicles” to see what you can learn from the misfortune of others.

Rx-ploiting Medicare and Medicaid

The Kickback Chronicles, Episode 12On this week’s episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar look at a North Carolina Medicaid fraud scheme in which Medicaid recipients were required to submit medical unnecessary urine specimens that were billed to the North Carolina Medicaid program in order to participate in subsidized housing programs, after school programs, and mental health and other clinics. Listen now to this episode of the “Kickback Chronicles” to see what you can learn from the misfortune of others.

The Kickback Chronicles, Episode 12 On this week’s episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar look at a North Carolina Medicaid fraud scheme in which Medicaid recipients were required to submit medical unnecessary urine specimens that were billed to the North Carolina Medicaid program in order to participate in subsidized housing programs, after school programs, and mental health and other clinics. Listen now to this episode of the “Kickback Chronicles” to see what you can learn from the misfortune of others.

Urine Trouble

Check out Health Law Expressions -- our new podcast, in which HortySpringer attorneys give their take in 15 minutes or less on cutting edge developments in health law in 15 minutes or less, and have some fun while doing so.  You give us 15 minutes, we’ll give you the law.

 The Kickback Chronicles, Episode 11On this week’s episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar review the recent sentencing of two individuals connected with over prescribing Subsys, one of the drugs at the center of the opioid crisis.  Listen now to this episode of the “Kickback Chronicles” to see what you can learn from the misfortune of others.

The Kickback Chronicles, Episode 11 On this week’s episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar review the recent sentencing of two individuals connected with over prescribing Subsys, one of the drugs at the center of the opioid crisis.  Listen now to this episode of the “Kickback Chronicles” to see what you can learn from the misfortune of others.

The Pain Caused by Lying to the Feds

The Joint Commission announced in mid-December that, effective immediately, hospitals could begin reappointing and renewing clinical privileges for practitioners every three years, rather than every two years.  This is nothing new for those hospitals accredited by the DNV, but with this announcement, many hospitals accredited by TJC are considering moving to a three-year appointment period.  Before making this decision, there are several factors that you should evaluate.  For example, what changes will you need to make to your Medical Staff governance documents, does state law permit you to reappoint practitioners every three years (some do not), and are there changes to your peer review process that you will need to make to ensure that patients are protected if a longer appointment term is adopted.  Join Horty, Springer and Mattern attorneys Susan Lapenta and Charles Chulack for this podcast episode that provides the answers to these questions and more!

The Joint Commission announced in mid-December that, effective immediately, hospitals could begin reappointing and renewing clinical privileges for practitioners every three years, rather than every two years.  This is nothing new for those hospitals accredited by the DNV, but with this announcement, many hospitals accredited by TJC are considering moving to a three-year appointment period.  Before making this decision, there are several factors that you should evaluate.  For example, what changes will you need to make to your Medical Staff governance documents, does state law permit you to reappoint practitioners every three years (some do not), and are there changes to your peer review process that you will need to make to ensure that patients are protected if a longer appointment term is adopted.  Join Horty, Springer and Mattern attorneys Susan Lapenta and Charles Chulack for this podcast episode that provides the answers to these questions and more!

Moving to a Three-Year Appointment Period – Is Now the Time?

The Kickback Chronicles, Episode 10On this week’s episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar turn their focus to telemedicine fraud in the pharmaceutical industry. With help from an industry expert, they take a closer look at some common themes to look for and avoid in the pharmaceutical world. Listen now to this episode of the “Kickback Chronicles” to see what you can learn from the misfortune of others. 

The Kickback Chronicles, Episode 10 On this week’s episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar turn their focus to telemedicine fraud in the pharmaceutical industry. With help from an industry expert, they take a closer look at some common themes to look for and avoid in the pharmaceutical world. Listen now to this episode of the “Kickback Chronicles” to see what you can learn from the misfortune of others.

The Alchemy of Fraud

The Kickback Chronicles, Episode 9On this week’s episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar dive into the world of telemedicine. The expansion of access to telemedicine services during the COVID-19 pandemic has opened the door to a whole new type of fraud.  Join us as we take a closer look at how the OIG will be identifying and evaluating these types of cases as well as some of the most recent victims of the OIG’s crackdown on telemedicine.    Listen now to this episode of the “Kickback Chronicles” to see what you can learn from the misfortune of others.

The Kickback Chronicles, Episode 9 On this week’s episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar dive into the world of telemedicine. The expansion of access to telemedicine services during the COVID-19 pandemic has opened the door to a whole new type of fraud.  Join us as we take a closer look at how the OIG will be identifying and evaluating these types of cases as well as some of the most recent victims of the OIG’s crackdown on telemedicine.    Listen now to this episode of the “Kickback Chronicles” to see what you can learn from the misfortune of others.

Ain’t No Stopping It Now, Telemedicine Is Here to Stay!

The Kickback Chronicles, Episode 8On this week’s episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar take a closer look at a recent case involving an alleged kickback scheme between an engaged couple on separate ends of a financial relationship. In what first appeared to be a shut and close case, now remains unfinished. Learn how just two words changed everything.   Listen now to this episode of the “Kickback Chronicles” to see what you can learn from the misfortune of others.

The Kickback Chronicles, Episode 8 On this week’s episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar take a closer look at a recent case involving an alleged kickback scheme between an engaged couple on separate ends of a financial relationship. In what first appeared to be a shut and close case, now remains unfinished. Learn how just two words changed everything.   Listen now to this episode of the “Kickback Chronicles” to see what you can learn from the misfortune of others.

But For the Grace of Fraud Go I

The Kickback Chronicles, Episode 7On this week’s episode of The Kickback Chronicles, HortySpringer attorneys Henry Casale and Hala Mouzaffar take a closer look at a recent case involving a woman who just couldn’t get enough of the Department of Justice. While awaiting sentencing for a guilty plea of health care fraud, this week’s schemer got herself involved in yet another Medicaid billing scheme. Listen now to this episode to see what you can learn from the misfortune of others.

The Kickback Chronicles, Episode 7 On this week’s episode of The Kickback Chronicles, HortySpringer attorneys Henry Casale and Hala Mouzaffar take a closer look at a recent case involving a woman who just couldn’t get enough of the Department of Justice. While awaiting sentencing for a guilty plea of health care fraud, this week’s schemer got herself involved in yet another Medicaid billing scheme. Listen now to this episode to see what you can learn from the misfortune of others.

Oops!... She Committed Fraud Again

The Kickback Chronicles, Episode 6On this week’s episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar flip the script and examine the government’s investigation tactics when examining fraud cases. As they walk through the process using a recent case, you will get a sense of the resources the government has at its fingertips and just what lengths it will go to prove fraud beyond a reasonable doubt.  Listen now to this episode of the “Kickback Chronicles” to see what you can learn from the misfortune of others.

The Kickback Chronicles, Episode 6 On this week’s episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar flip the script and examine the government’s investigation tactics when examining fraud cases. As they walk through the process using a recent case, you will get a sense of the resources the government has at its fingertips and just what lengths it will go to prove fraud beyond a reasonable doubt.  Listen now to this episode of the “Kickback Chronicles” to see what you can learn from the misfortune of others.

To Catch a Fraudster

The Kickback Chronicles, Episode 5On this week’s episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar look into the world of fraudulent COVID-19 Vaccination Cards by taking a deeper dive into two recent cases involving forged and fraudulent vaccination cards.  Although fraudulent vaccination cards were the root of these crimes, you’ll be shocked to learn the series of events that led up to charges being filed and the subsequent guilty pleas entered.  Listen now to this episode of the “Kickback Chronicles” to see what you can learn from the misfortune of others.

The Kickback Chronicles, Episode 5 On this week’s episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar look into the world of fraudulent COVID-19 Vaccination Cards by taking a deeper dive into two recent cases involving forged and fraudulent vaccination cards.  Although fraudulent vaccination cards were the root of these crimes, you’ll be shocked to learn the series of events that led up to charges being filed and the subsequent guilty pleas entered.  Listen now to this episode of the “Kickback Chronicles” to see what you can learn from the misfortune of others.

Proof of Vaccination Required

The Kickback Chronicles, Episode 4On this week’s episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar look at the recent guilty plea of the owner and operator of a marketing company that conducted business with medical testing companies. What began as a scheme to defraud Medicare out of funds related to genetic testing, turned into a bigger opportunity at the onset of the COVID-19 pandemic. This case will show the government’s crackdown on fraud in connection with COVID-19 and leave you wondering if this is just the tip of the iceberg.  Listen now to this episode of the “Kickback Chronicles” to see what you can learn from the misfortune of others.

The Kickback Chronicles, Episode 4 On this week’s episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar look at the recent guilty plea of the owner and operator of a marketing company that conducted business with medical testing companies. What began as a scheme to defraud Medicare out of funds related to genetic testing, turned into a bigger opportunity at the onset of the COVID-19 pandemic. This case will show the government’s crackdown on fraud in connection with COVID-19 and leave you wondering if this is just the tip of the iceberg.  Listen now to this episode of the “Kickback Chronicles” to see what you can learn from the misfortune of others.

Fraud is in their Genes

Hospitals often review and revise their medical staff bylaws and policies to keep up with new developments, but many rarely or ever pay attention to their hospital corporate bylaws.  Corporate bylaws are required to contain provisions required by CMS, the IRS, state licensure agencies, and accrediting bodies, but if they haven’t been updated in a while they may not meet these requirements. Corporate bylaws should also compliment and supplement medical staff documents, but if they are inconsistent with medical staff documents it can spell trouble if there is ever a dispute over credentialing or privileging.  HortySpringer partners Lauren Massucci and Dan Mulholland will explore this topic in their current podcast and tell you what you should be looking for when you dust your corporate bylaws off to see what’s in them. 

Hospitals often review and revise their medical staff bylaws and policies to keep up with new developments, but many rarely or ever pay attention to their hospital corporate bylaws.  Corporate bylaws are required to contain provisions required by CMS, the IRS, state licensure agencies, and accrediting bodies, but if they haven’t been updated in a while they may not meet these requirements.  Corporate bylaws should also compliment and supplement medical staff documents, but if they are inconsistent with medical staff documents it can spell trouble if there is ever a dispute over credentialing or privileging.  HortySpringer partners Lauren Massucci and Dan Mulholland will explore this topic in their current podcast and tell you what you should be looking for when you dust your corporate bylaws off to see what’s in them.

Have You Looked at Your Corporate Bylaws Lately?  Do You Even Know Where They Are?

Health Law Expressions

 Horty Springer and Mattern partners Dan Mulholland and Henry Casale discuss very recent developments from the Office of Inspector General of HHS in terms of reviewing the False Claims Act at the State level and whether it complies with federal rules.  Discussion includes a review of the False Claims Act to see if states will qualify for a 10 percent increase in any share of a False Claims Act settlement. 

Horty Springer and Mattern partners Dan Mulholland and Henry Casale discuss very recent developments from the Office of Inspector General of HHS in terms of reviewing the False Claims Act at the State level and whether it complies with federal rules.  Discussion includes a review of the False Claims Act to see if states will qualify for a 10 percent increase in any share of a False Claims Act settlement.

State False Claims Acts - Something Else to Keep You Up At Night

Ian Donaldson and Joshua Hodges of Horty Springer and Mattern share ideas on how to lesson the overwhelming process of credentialing faced by medical staff offices. Listen as they share insightful tips learned from many years of helping hospitals and healthcare systems of all sizes.

Ian Donaldson and Joshua Hodges of Horty Springer and Mattern share ideas on how to lesson the overwhelming process of credentialing faced by medical staff offices. Listen as they share insightful tips learned from many years of helping hospitals and healthcare systems of all sizes.

Overwhelmed in the Medical Staff Office

 Horty Springer and Mattern partners Dan Mulholland and Henry Casale discuss a False Claims Act case that was based on the Stark Law in which the Third Circuit Court of Appeals interpreted the Stark Law to question whether most RVU compensation models were permitted by the Stark Law. However, as proof that not even the federal courts understand the Stark Law, the Third Circuit vacated its September 17th decision and reissued its opinion on December 20. The new Opinion corrected some of the more egregious errors that were included in the September Opinion. However, it still leaves a number of questions about Stark unanswered. 

Horty Springer and Mattern partners Dan Mulholland and Henry Casale discuss a False Claims Act case that was based on the Stark Law in which the Third Circuit Court of Appeals interpreted the Stark Law to question whether most RVU compensation models were permitted by the Stark Law. However, as proof that not even the federal courts understand the Stark Law, the Third Circuit vacated its September 17th decision and reissued its opinion on December 20. The new Opinion corrected some of the more egregious errors that were included in the September Opinion. However, it still leaves a number of questions about Stark unanswered.

US ex rel. Bookwalter — The Shape of Stark to Come

Ian Donaldson partner at the firm Horty Springer and Mattern discusses the growing problem of physician burnout and how to help educate, receive and process feedback and eliminate the frustrations experienced by your medical staff. 

Ian Donaldson partner at the firm Horty Springer and Mattern discusses the growing problem of physician burnout and how to help educate, receive and process feedback and eliminate the frustrations experienced by your medical staff.

Burnout

Dan Mulholland and Henry Casale, senior partners at Horty Springer and Mattern, discuss the implications of the changes in tax laws that will impose excise tax on excess compensation paid by exempt organizations.The so-called Triple Ex Provision.

Dan Mulholland and Henry Casale, senior partners at Horty Springer and Mattern, discuss the implications of the changes in tax laws that will impose excise tax on excess compensation paid by exempt organizations.The so-called Triple Ex Provision.

Excess Compensation Causes Excess Trouble

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