HortySpringer Health Law Expressions

When hospitals and health systems are pursuing a merger or affiliation, there is a natural tendency to move things along quickly. While it is ok to conduct due diligence, explore potential efficiencies and plan for what might be possible if the affiliation takes place, the parties need to refrain from acting like they are already affiliated, implementing plans or sharing competitively sensitive in...

On this week’s episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar turn their attention to a small town in Tennessee to look at a provider that helped exacerbate the opioid crisis in his community for fame and fortune.   Listen now to this episode of the “Kickback Chronicles” to see what you can learn from the misfortune of others.

Two recent lawsuits decided by Utah courts draw attention to the importance of strong, broad release language protecting physician leaders who volunteer to participate in credentialing, peer review, and other medical staff activities. In both cases, the physicians challenging peer review activity argued that the release language set forth in the Medical Staff Bylaws should not be applied to block...

On this week’s episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar take their first look at for-profit hospitals to discuss a unique case involving a hospital, its investors, and an attempt to avoid repaying Medicare.   Listen now to this episode of The Kickback Chronicles to see what you can learn from the misfortune of others. 

CMS recently clarified that physicians can give orders via test in hospitals and critical access hospitals.  But the texts have to be through a secure system, and computerized physician order entry is still preferred. Join HortySpringer attorneys Dan Mulholland and Mary Paterni as they discuss this new CMS guidance and also talk about the dangers of texting in general.

On this episode, HortySpringer attorneys Henry Casale and Hala Mouzaffar take a look at cases happening in their own backyard to show that healthcare fraud can happen anywhere.   Listen now to this episode of the “Kickback Chronicles” to see what you can learn from the misfortune of others.

The Office of Inspector General recently published its General Compliance Program Guidance. The GCPG is a reference guide for the health care compliance community and other health care stakeholders. It is chock-full of information about relevant Federal laws, compliance program infrastructure, OIG resources, and other information useful to understanding health care compliance.  While the GCPG is v...

On this week’s episode of The Kickback Chronicles, HortySpringer attorneys Henry Casale and Hala Mouzaffar look back at cases they have discussed over the last year to see where the defendants are today, what sentences they actually received, and if any old habits die hard.  Listen now to this episode  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.

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 viola...

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.

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 cas...

 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 m...

 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...

 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...

 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.  

 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...

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 he...

 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 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.  Befor...

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 lear...

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...

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 th...

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 schem...

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 reas...