August 3, 2020

The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services, the primary enforcer of fraud and abuse prohibitions, posted Advisory Opinion No. 15-12 on August 13, 2015, which makes it clear that  agencies may provide “introductory” or coor...

July 27, 2020

The Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, the primary enforcer of fraud and abuse prohibitions, recently issued two press releases that once again call into question common practices in the home care industry.  These pr...

July 21, 2020

Many hospitals refer patients on a regular basis to post-acute providers, including skilled nursing facilities (SNFs), assisted living facilities (ALFs), home health agencies, private duty home care agencies, hospices, and home medical equipment (HME) companies.  Relat...

July 14, 2020

In Aetna Life Insurance Company v. Humble Surgical Hospital, Civil Action H-12-1206, U. S. District Court, S.D. Texas, Aetna won a lawsuit against a Texas hospital, Humble Surgical Hospital, based on kickbacks paid by the hospital to referring physicians.  This decisio...

Anecdotally, providers often report that expectations of referral sources include the provision of services to patients free of charge.  A number of concerns about this practice have been raised, including questions about whether this practice is compliant with require...

June 29, 2020

Anecdotally, there is increasing recognition that transitions in care are the most dangerous times for patients.  These transitions range from shift changes in institutions, such as hospitals and SNFs, to changes from one level of care to other levels of care.  In addi...