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 Qui Tam Action Alleging Violation of Stark & Anti-kickback
Headed to Trial
Carlisle Hospital (Carlisle) and its parent company, Health Management Associates, Inc. (HMA) are proceeding to trial with the ruling of the U.S. District Court for the middle district of Pennsylvania on March 31, 2010, reversing the 2007 decision, which stated that the actions of Carlisle and HMA fell under the personal services exception of the Stark law. The qui tam action alleged that Carlisle and HMA violated Stark law and the Anti-kickback statute in its arrangement with Blue Mountain Anesthesia Associates, P.C. (BMAA).
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Increased Regulatory Scrutiny Possible with Expanded Use of Billing &
Coding Audits
On March 10, 2010, President Obama issued a memorandum regarding finding and recapturing improper payments in Medicare, Medicaid, and other government programs through the use of Payment Recapture Audits, for the purpose of identifying improper payments made to contractors or other entities in which third-party private companies receive a percentage of the improper payments they recover from providers. Increased False Claims Act (FCA) exposure may result from a rising wave of billing and coding audits as a part of the enhanced federal enforcement efforts related to healthcare fraud and abuse.
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Impact of Healthcare Reform on Specialty Hospitals
The recent passage of healthcare reform has ignited a heated debate, with supporters and opponents of the bill squaring off over many of its provisions. One of the groups most heavily invested in the legislation are physician owners of specialty hospitals, as they stand to lose their ability to expand and compete in the marketplace under the provisions in the new reform bill (H.R. 3590), signed into law by President Obama on March 23, 2010. Under this landmark legislation, physician-owned specialty hospitals will encounter several barriers, which restrict ownership and expansion.
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