Although “telemedicine” is not some new type of medical breakthrough but rather a vehicle for the delivery of “medicine”, its wide-spread use in delivering medical care in many different scenarios can get bogged down by serious regulatory issues such as: the lack of medical license reciprocity among the states (notwithstanding an increasing number of states adopting the Federation of State Medical Boards Interstate Medical Licensure Compact); the type of informed consent that needs to be given before care is rendered via telemedicine; differing opinions from state-to-state about the standards of care specific to medical care delivered via “telemedicine”; inefficient availability of patient’s medical records and the privacy of those records from state-to-state; requirements for certificates of need in some states to practice even basic forms of medicine; even the types of entities that can legally employ doctors varies among the states. A high profile example of the challenge of standard of care issue’s confronting medical boards is well documented in the high-profile Texas cases involving Teladoc.
But numerous other states are having their own challenges that are not much different from Texas. For example, Ohio and Arkansashave had their own challenges.
Even in the absence of these regulatory issues in some states, you still have the fact that health insurers’ payment for telemedicine services currently amounts to less than 1 percent of all of the reimbursements paid to health care providers and health care facilities, although there is some movement on these fronts too.
While the promise of telemedicine technology as a form of connecting providers with their patients continues to innovate exponentially, adoption is way behind innovation. The hot topic for the past several years that garners the most news coverage is “convenience care”, but that is just one aspect of the true value that telemedicine can bring to the table in the delivery of medical care. Read More
Marc Stephen Raspanti will speak on “Best Practices for Dealing with the States in False Claims Act Investigations, Litigation and Settlement,” at the Healthcare Enforcement Compliance Institute. He will be co-presenting with Candice M. Deisher, Assistant Attorney General, Virginia Attorney General’s Office. The event takes place from October 23-26, 2016 in Washington D.C. Read More
This week, the Securities and Exchange Commission (“SEC”) announced its enforcement statistics for Fiscal Year (“FY”) 2016. All told, the agency filed 868 enforcement actions, including a record 548 independent actions for violations of federal securities law, and recovered more than $4 billion in disgorgement and penalties. The number of independent enforcement actions represents an 8% increase over the number of such actions filed in FY 2015 (507) and a 32% increase over those filed in FY 2014.
The agency has yet to release its Select SEC and Market Data, the report that will break down the quantity and types of enforcement actions pursued. However, the overview contained in this week’s announcement provides some insight into the agency’s foci for the past year, and likely going forward.
Foreign Corrupt Practices – The SEC filed 21 actions to enforce the Foreign Corrupt Practices Act (“FCPA”) and announced two non-prosecution agreements with companies that self-reported FCPA violations. The 21 actions are a high-water mark for FCPA enforcement for the SEC. The agency’s increased efforts to pursue American companies for conduct committed overseas is consistent with public statements made by SEC officials throughout FYs 2015 and 2016. Businesses should anticipate that the SEC will increase its FCPA enforcement in the upcoming fiscal year.
Rewarding Whistleblowers – The SEC whistleblower program distributed to 13 recipients more than $57 million – more money than the program has distributed in all other years combined since its 2011 inception, and a 50% increase over its payouts from FY 2015 ($38 million).
The SEC also brought the agency’s first-ever standalone action for retaliation against a whistleblower and charged three companies with violating Exchange Act Rule 21F-17, which prohibits the use of confidentiality agreements to impede a whistleblower from communicating with the SEC. These protective actions on behalf of whistleblowers, coupled with ever-growing distributions, signal that the SEC has an increased sense of purpose surrounding the development of its whistleblower program. Read More
Pamela Coyle Brecht will be a panelist at the 2016 Federal Litigation and Qui Tam Conference for the Federal Bar Association in Washington, D.C. She will participate in the Qui Tam breakout session titled, “Health Law and the False Claims Act.” Read More
On Monday, the DOJ announced the resolution of criminal allegations and a False Claims Act (“FCA”) lawsuit a relating to a scheme to defraud the United States and obtain kickbacks in exchange for patient referrals. A major U.S. hospital chain, Tenet Healthcare Corporation and two subsidiaries, Atlanta Medical Center, Inc. and North Fulton Medical Center, Inc., will pay over $513 million pursuant to a series of agreements, including a civil settlement agreement, non-prosecution agreement, and plea agreements:
FCA settlement: Tenet Healthcare and related entities – described in the settlement as “the Tenet Entities – agreed to pay $368 million to the federal government and to Georgia and South Carolina to resolve claims brought by a Georgia whistleblower. The FCA suit was filed in the Middle District of Georgia and claimed that Tenet Healthcare paid bribes and kickbacks to pre-natal clinics to unlawfully refer Medicare and Medicaid patients to its hospitals. The whistleblower will receive $84 million under the agreement. The agreement stated that the Tenet Entities denied any liability regarding the false claims allegations.
Non-prosecution agreement: Tenet HealthSystem Medical Inc., the corporate parent of Tenet Healthcare, entered into a non-prosecution agreement (“NPA”) with DOJ based on similar allegations to those within the FCA case. The NPA allows the two companies to avoid criminal prosecution in exchange for following the agreed-upon terms. The criminal allegations at the heart of the NPA focused on an alleged conspiracy to defraud the United States and to violate the Anti-Kickback Statute, which bars illegal payments that induce patient referrals for services paid for by federal health care programs. Under the NPA, Tenet HealthSystem and Tenet Healthcare will avoid criminal prosecution if they cooperate with the government’s prosecution and strengthen their internal controls, including their compliance and ethics programs. The NPA is effective for three years, although it may be extended for an additional year if necessary. Read More
PHILADELPHIA, PA – Pamela Coyle Brecht, partner at the law firm Pietragallo Gordon Alfano Bosick & Raspanti, LLP, will be a panelist at the 2016 Federal Litigation and Qui Tam Conference for the Federal Bar Association, in Washington, D.C. on Tuesday, October 18, 2016.
Ms. Brecht will participate in the Qui Tam breakout session titled, “Health Law and the False Claims Act.” Health care fraud is the biggest area of False Claims Act litigation. The session will be moderated by Matt Wolfe, Parker Poe Adams & Bernstein LLP. Ms. Brecht will be joined on the panel by Jay Holland, Joseph Greenwald & Lake PA. They will discuss recent trends and developments in the health care field as it relates to FCA litigation.
Ms. Brecht is an active member of the Qui Tam practice group at Pietragallo. She is also experienced in white collar criminal litigation, employment law, internal investigations and complex health care litigation. She litigates some of the most complex False Claims Act cases filed in the United States. Her cases have included alleged fraud by a large multi-state Medicaid managed care contractor, FCA violations by three of the largest hospital corporations in the country, and complex financial relationships among healthcare providers including Stark and Anti-Kickback issues.
Ms. Brecht is a 1988, cum laude, graduate of Villanova University and a 1991 graduate of Temple University School of Law. While attending Temple University School of Law, Ms. Brecht served as a member of the Temple Law Review and received honors for Distinguished Class Performance. Ms. Brecht is a member of the Philadelphia Bar Association, the American Health Lawyers Association, the Health Care Compliance Association, and the Federal Bar Association Qui Tam Section.
For more information regarding the upcoming conference or to register, please visit http://www.fedbar.org/fedlitquitam16. Read More
Marc Stephen Raspanti, Doug E. Roberts, and Pamela Coyle Brecht authored “A New Era of Laboratory Fraud, Part 2: The Return of Laboratory Fraud” which was published in the HCCA’s Compliance Today October 2016 Issue. Part 1 was featured in the September 2016 Issue.
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A New Era of Laboratory Fraud, Part 2: The Return of Laboratory Fraud Read More
The U.S. Court of Appeals for the Third Circuit granted Senator Robert Menendez’s motion to stay its mandate while he petitions the U.S. Supreme Court to review whether the political corruption charges against him are based on constitutionally protected legislative acts. As previously documented on this blog, Menendez moved to dismiss the indictment filed in the U.S. District Court for the District of New Jersey. He argued in part that the Speech and Debate Clause of the U.S. Constitution insulated him from prosecution on his alleged efforts to influence various government actions on behalf of prominent Democratic Party donor, Dr. Salomon Melgen.
After the district court denied the motion as to the bulk of Menendez’s charges, Menendez appealed to the Third Circuit. On July 29, 2016, the Court found that Menendez’s acts were “ambiguously legislative” and thus subject to the district court’s determination as to whether they were protected activity based on its evaluation of Menendez’s motive and purpose. The Court then found “a sufficient basis for the [district] court’s conclusion that the predominant purpose of the challenged acts was to pursue a political resolution to Dr. Melgen’s disputes,” and affirmed the denial of the motion to dismiss.
The affirmance green-lighted Menendez’s trial, but the stay will put the brakes on any further proceedings until (1) Menendez petitions the Supreme Court for a Writ of Certiorari – i.e., the opportunity to be heard – and (2) the high court decides whether to grant cert. In a typical year, the Supreme Court agrees to review between 1% and 6% of the criminal cases in which a cert petition is filed. Most successful cert petitions present important questions of federal law that lower courts have answered inconsistently.
In opposing Menendez’s motion for a stay, the government contended that Menendez’s claim was highly unlikely to engender Supreme Court review. Read More
Joseph L. Gordon authored “Employers Feel Heat Following Summer’s Arbitration Agreement Cases” which was published in The Legal Intelligencer on September 28, 2016.
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Employers Feel Heat Following Summer’s Arbitration Agreement Cases Read More
