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How CGX Laboratories Can Be Compliant
Medicare began providing coverage for genetic cancer screening (CGX) in 2018. While this was a positive development for testing laboratories, some labs that have been billing Medicare for CGX have run into compliance issues. If your testing laboratory bills Medicare for CGX, this article provides an overview of what you...
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CBD Compliance for Pharmacists
More patients are coming to you every day asking about CBD oil and other cannabis-based treatments and medications. Here’s what you need to know in order to maintain federal compliance. When the federal Agriculture Improvement Act of 2018 (commonly known as the “Farm Bill”) was passed late last year, hemp...
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Alzheimer’s Testing Compliance
According to the National Institutes of Health (NIH), it is estimated that more than 5.5 million Americans may suffer from Alzheimer’s disease. Among other things, this means that diagnosing and treating seniors with Alzheimer’s disease presents a significant opportunity for neurologists, psychiatrists, geriatricians, and other health care providers to help...
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Health Care Fraud Involving Home Sleep Studies: What Do California Doctors and Service Providers Need to Know?
A recent trend in health care fraud enforcement involves private insurers and the federal government targeting doctors who recommend patients for home sleep studies (HSS) and HSS service providers. Currently, the insurance companies and federal agencies including the U.S. Department of Justice (DOJ) and the U.S. Department of Health and...
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Continuous Glucose Monitoring (CGM) Medicare Compliance
In 2018, the Centers for Medicare and Medicaid Services (CMS) expanded Medicare coverage for continuous glucose monitoring (CGM). While this is good news for program beneficiaries who need CGM, billing compliance has proven to be a challenge for many pharmacies and other health care providers. When continuous glucose monitoring (CGM)...
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Why Should You Try to Prove “No Intent” in a False Claims Act Investigation or Other Federal Criminal Case?
In federal cases involving allegations of health care fraud and various other white-collar offenses, the difference between facing criminal charges and civil charges (or no charges at all) is often the element of criminal “intent.” If you are being targeted under a statute such as the False Claims Act that...
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What are the Levels of Intent in Federal Criminal Cases?
When prosecuting a federal criminal case, a key aspect of the government’s burden of proof is establishing the requisite mens rea, or “criminal state of mind.” Unlike civil cases, in which evidence of intent generally is not required (although there are some exceptions), in criminal cases the government must necessarily...
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Criminal ERISA Investigations Targeting Multiemployer Retirement Plans (MEPs)
As explained by the Pension Benefit Guaranty Corporation (PBGC), “[a] multiemployer plan is a collectively bargained plan maintained by more than one employer, usually within the same or related industries, and a labor union. These plans are often referred to as ‘Taft-Hartley plans.’” Multiemployer plans can often be cost-effective options...
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What Does the Federal Government Have to Prove in Order to Establish Criminal “Intent”?
In many cases, the federal government has the option to either pursue civil or criminal charges against an individual suspected of violating the law. In deciding whether to pursue civil or criminal charges, the key distinguishing factor is often the element of criminal “intent.” While many federal laws allow for...
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Criminal ERISA Enforcement Involving Pensions and 401(k) Plans
Employer-sponsored retirement plans are subject to the requirements of the Employee Retirement Income Security Act of 1974 (more-commonly known by its acronym, “ERISA”). While ERISA violations involving pensions and 401(k) plans have the potential to lead to civil litigation – including potential class action litigation – an even greater risk...
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