Finds that the U.S. Department of Health and Human Services put its “thumb on the scale”
On Monday February 8, a judge in the Eastern District of Texas again rejected the U.S. Department of Health and Human Services (HHS) Independent Dispute Resolution (IDR) rules on the grounds that the Rules continued to “put a thumb on the scale” for the arbitrator’s reliance on the Qualified Payment Amount (QPA) contrary to the statutory language of the No Surprises Act.
It has been four years since Congress enacted the Eliminating Kickbacks in Recovery Act (“EKRA”), codified at 18 U.S.C. § 220. EKRA initially targeted patient brokering and kickback schemes within the addiction treatment and recovery spaces. However, since EKRA was expansively drafted to also apply to clinical laboratories (it applies to improper referrals for any “service”, regardless of the payor), public as well as private insurance plans and even self-pay patients fall within the reach of the statute.
On April 20, 2022, the U.S. Department of Justice (“DOJ”) announced a nationwide coordinated law enforcement action to combat health care-related COVID-19 fraud. In line with the announcement, the federal government has continued throughout this year to focus its enforcement on fraud in the COVID-19 space, particularly on misuse of Provider Relief funds and COVID-19 testing fraud.
Recent Updates
- ABA and FWA: Compliance Best Practices
- Regulatory Scrutiny in ABA: What Providers Need to Know About Compliance Oversight
- When Clear Drafting is Not Enough: Fifth Circuit Rejects a “Sole Discretion” Arbitration Clause
- ABA and FWA: Legitimate Providers Operate in a High-Risk Environment
- Powerful Tool, but Not an Attorney: Massachusetts Court Rejects Work Product Protection for AI-Generated Documents