Mutual Matters

Scott R. Grubman, Esq.

Recent Posts

DOJ Announces Two Large False Claims Act Settlements

Posted by Scott R. Grubman, Esq. on Aug 30, 2018 12:03:00 PM

Earlier this month, the Department of Justice (DOJ) announced two large settlements under the False Claims Act (FCA) against hospital systems:

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Topics: Billing and Reimbursement

CMS Proposes Potential Changes to Documentation Requirements

Posted by Scott R. Grubman, Esq. on Aug 23, 2018 11:57:40 AM

On July 27, 2018, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule containing numerous proposed changes to the Medicare physician fee schedule and other Medicare policies. The proposed rule is intended to update Medicare’s payment systems to better reflect the relative value of services. 

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Topics: Patient Care and Interaction, Billing and Reimbursement

CMS Announces Plans for Interagency Group to Review Stark Law

Posted by Scott R. Grubman, Esq. on Jun 14, 2018 11:58:00 AM

Earlier this year, the Centers for Medicare and Medicaid Services (CMS) announced that it was forming an interagency group to review potential changes to the federal Stark (or physician self-referral) Law. The federal Stark Law generally prohibits a physician from referring certain designated health services to an entity with which the physician, (or an immediate family member of the physician), has a financial relationship. 

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Topics: Licensure and Discipline

OIG Estimates Medicare Paid Over $700 Million in Noncompliant EHR Incentive Payments

Posted by Scott R. Grubman, Esq. on Sep 26, 2017 1:00:00 PM

Scott R. Grubman, Esq. Gregory A. Tanner, Esq. Chilivis, Cochran, Larkins & Bever, LLP

On June 7, 2017, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) released a report estimating that Medicare paid over $729 million in improper EHR incentive payments to healthcare providers who did not meet meaningful use requirements. 

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DOJ Announces Establishment of Opioid Fraud and Abuse Detection Unit

Posted by Scott R. Grubman, Esq. on Aug 30, 2017 9:08:47 AM

Scott R. Grubman, Esq.
Gregory A. Tanner, Esq.

Chilivis, Cochran, Larkins & Bever, LLP

In response to the nationwide opioid epidemic, the U.S. Department of Justice (DOJ) has announced the creation of the Opioid Fraud and Abuse Detection Unit. 

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eClinicalWorks Agrees to Pay $155 Million to Settle False Claims Act Allegations

Posted by Scott R. Grubman, Esq. on Jul 20, 2017 1:00:00 PM

Written by, Scott R. Grubman, Esq., Gregory A. Tanner, Esq., Chilivis, Cochran, Larkins & Bever, LLP

On May 31, 2017, the U.S. Department of Justice (DOJ) announced that eClinicalWorks (ECW), one of the nation’s largest vendors of electronic health records (EHR) software, along with certain individual employees, has agreed to pay $155 million to settle allegations that ECW violated the federal False Claims Act (FCA).

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Medicaid Fraud Control Units Report Nearly $2 Billion in Recoveries

Posted by Scott R. Grubman, Esq. on May 25, 2017 1:05:00 PM

On March 6, 2017, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) published data regarding the enforcement activities of Medicaid Fraud Control Units (MFCUs) across the country during fiscal year 2016.

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Beware of Prescription Drugs and Devices from Foreign Sources

Posted by Scott R. Grubman, Esq. on May 5, 2017 1:00:00 PM

Recent enforcement actions by the US Food and Drug Administration (FDA) and the US Department of Justice (DOJ) highlight ongoing government scrutiny regarding the sources of prescription drugs and medical devices dispensed by healthcare providers. Importantly, this scrutiny is not limited to distributors: federal regulators have pursued criminal and civil actions against physicians and physician practices that receive drugs and devices from unauthorized sources. Accordingly, healthcare providers should take proactive steps to avoid obtaining drugs and devices from unauthorized sources, particularly foreign entities (e.g., online retail pharmacies based in foreign countries). 

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As one of the leading mutual providers of Medical Professional Liability insurance, we're here to help all healthcare professionals with the challenges they face on a daily basis. The topics we cover include: 

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