The differences and similarities between American and Italian healthcare fraud, waste, and abuse laws: Part 1

2021/11/01

This is Part 1 of a three-part series discussing the similarities and differences between the US and Italian healthcare fraud, waste, and abuse laws. Part 2 of this series will be published in the December issue of Compliance Today, and Part 3 will be published in January 2022 issue of the magazine. The United States of America and the Italian Republic share many common ideals. America was named after Amerigo Vespucci, an Italian explorer.[1] The American Constitution is based on the principle of government “of the people, by the people, for the people.” The Italian Constitution embodies this same principle in the ideals of sovereignty to the people: “La sovranità appartiene al popolo.” As of 2003, almost 16 million Americans claimed to have had Italian heritage.[2] With shared values, our two countries have forged an indelible alliance. These allied nations work together as world leaders in responding to a wide variety of economic, political, medical, technological, and scientific challenges that confront a rapidly changing world. A major challenge confronting both America and Italy is providing a healthcare system that extends medical treatment that is effective, innovative, devoid of fraud, and cost efficient. While the healthcare systems in America and Italy differ in many respects, they suffer from the same obstacles: fraud, waste, and abuse. Both countries take these problems seriously. For example, in America, the federal government recovered more than $2.2 billion in 2020 alone from healthcare fraud and false claims,[3] while in Italy the National Anti-Corruption Authority (Autorità Nazionale Anticorruzione) is actively monitoring, preventing, and responding to corruption, as well as issuing anti-corruption plans. This article highlights laws enacted in America and Italy to combat fraud, waste, and abuse, showing important similarities as well as differences between these enforcement efforts. Given the close historical and commercial ties between America and Italy, including healthcare companies that regularly operate in both countries, all stakeholders involved in healthcare (i.e., Read More

Privacy, Data and Cyber Security: The Current Legal Landscape CLE (Webinar)

2021/11/11

Companies and consumers alike are under perpetual assault from bad actors as IoT, work from home, and cloud migration – all intended to improve productivity – have expanded the cyber attack surface. The continually evolving privacy legislation and cyber regulation requires companies to adapt and comply with collection, use, retention, and disclosure of personal information, and requires the implementation of internal controls, systems, and policies to better protect information from cyber criminals. During this one hour CLE hosted webinar we will discuss: An overview of the current state of U.S. privacy law, including state privacy legislation, breach notification, and enforcement Overview of the legal framework in data security Cybersecurity threats and the attendant risk Regulatory frameworks and the future of managing security in large supply chains Best practices for companies to launch or improve their security program Click here to register. Zoom details to follow. *Attendance is limited. When Thursday, November 11, 2021 12:00 p.m. – 1:00 p.m. EST Host Christopher A. Iacono, Partner Martin T. Shepherd, Partner Credit CLE credit in PA is currently pending approval. Read More

Michael Morse to present at American Bar Association Physicians Legal Issues: Healthcare Delivery & Innovation Virtual Conference

2021/09/24

Michael A. Morse will present “With Friends Like These…The Attorney-Physician Expert Witness Relationship” at the American Bar Association Physicians Legal Issues: Healthcare Delivery & Innovation Virtual Conference on Friday, September 24, 2021 This live, interactive webinar will cover critical topics, including new payment models, compliance issues, enforcement trends, contracting, tips for managing transactions, cybersecurity, the implications of new technologies, and workplace issues for physicians. Speakers will share practical and viable improvement techniques to help you work more efficiently while restoring your sense of purpose. Mr. Morse’s panel will discuss how to find an appropriate expert witness, maintain attorney-client privilege, and guard against Daubert challenges from an attorney’s perspective. His panel also analyzes the physician expert viewpoint, including determining if a case is a good fit, the typical process for expert witness engagement, and preparation tips for deposition and trial testimony. For more information about Physicians Legal Issues: Healthcare Delivery & Innovation Virtual Conference please visit here. Read More

20 Pietragallo Lawyers Named in 2022 The Best Lawyers in America and Ones to Watch

2021/08/19

Pietragallo Gordon Alfano Bosick & Raspanti, LLP is pleased to announce that 20 lawyers have been named as 2022 The Best Lawyers in America and 2022 Ones to Watch, including two lawyers who were recognized for Bet-the-Company Litigation. Best Lawyers employs a sophisticated, conscientious, rational, and transparent survey process designed to elicit meaningful and substantive evaluations of the quality of legal services. Recognition by Best Lawyers is based entirely on peer review. The following were chosen as The Best Lawyers in America: Gaetan Alfano (Bet-the-Company Litigation) Pamela Coyle Brecht Phillip R. Earnest Mark Gordon James W. Kraus James F. Marrion Richard J. Parks William Pietragallo, II (Bet-the-Company Litigation) Francis E. Pipak, Jr. Kevin E. Raphael Marc Stephen Raspanti Douglas K. Rosenblum Clem C. Trischler Peter St. Tienne Wolff The following were chosen as The Best Lawyers in America: Ones to Watch: John Kettering Leslie A. Mariotti Peter W. Nigra Frank H. Stoy   About Pietragallo Pietragallo Gordon Alfano Bosick & Raspanti, LLP is a multi-disciplined business and commercial litigation firm headquartered in Pittsburgh with five offices throughout Pennsylvania, Ohio, and West Virginia from which we serve our clients in all 50 states and the District of Columbia. Read More

Alliance Family of Companies and Ancor Capital Partners Pay $15.3M to Settle False Claims Suits

2021/07/22

The Department of Justice and the United States Attorney’s Office for the Southern District of Texas, has announced the settlement of six qui tam cases filed in Houston, Dallas, and Philadelphia.  The first of the six whistleblower cases was filed in the Southern District of Texas by Dr. Bhuvana Mandalapu and Dr. Ramakrisha Chava, two Texas-based physicians, against Defendants Alliance Family of Companies and Ancor Holdings LP (d/b/a Ancor Capital Partners).[1] Alliance Family of Companies (“Alliance”), based in Irving, Texas, was one of the largest providers of in-home neurological diagnostic electroencephalogram (“EEG”) services in the United States.[2]  Ancor Capital Partners, based in Southlake, Texas, is a private equity firm that invested in Alliance in 2017. Drs. Mandalapu and Chava alleged in their Qui Tam lawsuit that, since 2013: Alliance paid independent-contractor neurologists to interpret EEG tests and provided these test-interpretation reports for free to non-neurologist referring physicians to enable them to bill the professional component for the test interpretations, in return for these non-neurologist physicians ordering the EEG tests from Alliance, in violation of the Anti-Kickback Statute (“AKS”), 42 U.S.C. § 1320a-7b(b); Alliance chose the neurologists that it paid to provide interpretations of tests ordered by other physicians in return for those neurologists ordering EEG tests for their own patients from Alliance, in violation of the AKS; Alliance falsely billed Current Procedural Terminology (“CPT”) code 95957 for every video ambulatory EEG test performed when it did not perform the work required for the billing of the code; and Alliance falsely billed CPT code 95951 when its procedures met the requirements only for the lower-reimbursed CPT code 95953. Drs. Mandalapu and Chava also alleged in their Qui Tam lawsuit that Ancor Capital Partners, through its due diligence during the sale of Alliance, learned about Alliance’s payment of kickbacks and other false claims and, after the sale, it allowed that conduct to continue. Read More

Pamela Coyle Brecht to present at Seton Hall University School of Law

2021/06/15

Pamela Coyle Brecht, Chair of the firm’s Qui Tam & False Claims Act practice, will present “The False Claims Act and Dealing with Whistleblowers” at Seton Hall University School of Law on Tuesday, June 15, 2021. This four-day healthcare compliance certificate program immerses attendees in the statutes, regulations, and other guidance that comprise the body of law known as “fraud and abuse law.” Attendees examine health care-related laws and regulations alongside other compliance, ethics and integrity officers, legal counsel, health care consultants, and regulatory and medical affairs professionals. For more information about Seton Hall University School of Law’s U.S. Healthcare Compliance Certificate Program please visit their website. Read More

24 Pietragallo Lawyers Named in 2021 Pennsylvania Super Lawyers and Rising Stars

2021/06/08

Including Recognition in Top 100 in Pennsylvania and Top 100 In Philadelphia Pietragallo Gordon Alfano Bosick & Raspanti, LLP is pleased to announce that 24 attorneys have been named as 2021 Super Lawyers and 2021 Rising Stars, including two attorneys who were also recognized in the Top 100 in Pennsylvania and Top 100 in Philadelphia. Super Lawyers is a service of Thomson Reuters legal division which compiles a list of outstanding lawyers from more than 70 practice areas. Each year, a research team at Super Lawyers conducts a multi-phase selection process reviewing independent research, peer nominations, and peer evaluations. The following were chosen as Pennsylvania Super Lawyers: Gaetan J. Alfano (Top 100 in Philadelphia) Joseph J. Bosick Mark Gordon Christopher A. Iacono P. Brennan Hart James W. Kraus Michael A. Morse William Pietragallo, II Francis E. Pipak, Jr. Kevin E. Raphael Marc S. Raspanti (Top 100 in Pennsylvania and Top 100 in Philadelphia) Douglas K. Rosenblum John A. Schwab Clem C. Trischler Paul K. Vey The following were chosen as Pennsylvania Rising Stars: Jeremy E. Abay John R. Brumberg Sarah R. Goodman Joseph L. Gordon John W. Kettering Peter W. Nigra Peter St. Tienne Wolff About Pietragallo Pietragallo Gordon Alfano Bosick & Raspanti, LLP is a multi-disciplined business and commercial litigation firm headquartered in Pittsburgh with five offices throughout Pennsylvania, Ohio, and West Virginia from which we serve our clients in all 50 states and the District of Columbia. Read More

Michael A. Morse is Contributing Author to HCCA’s Complete Healthcare Compliance Manual

2021/04/27

Michael A. Morse, partner and member of the firm’s Government Enforcement, Compliance, and White Collar Litigation team, recently contributed to Health Care Compliance Association (HCCA’s) Complete Healthcare Compliance Manual. The manual overall provides new and experienced practitioners with guidance and insights on the fundamentals of program management, risk assessment, compliance training, auditing and monitoring, and much more. Michael is a contributing author to Chapter 3: Running an Effective Compliance Program, wherein he discusses that the hallmark of an effective compliance program is having robust internal reporting system. Read More

Genetic Databases and the Future of Medicine: Can Law and Ethics Keep Up? Perspectives and Analysis of a Conference, 13 Drexel L. Rev. 321

2021/01/01

“Genetic Databases and the Future of Medicine: Can Law and Ethics Keep Up? Perspectives and Analysis of a Conference,” 13 Drexel L. Rev. 321 (Jan 1, 2021) Read More

From our COVID-19 Response Team: Pennsylvania Business Guidance For Probable or Confirmed Case of COVID-19

2020/08/05

As COVID-19 continues to spread globally and throughout Pennsylvania, most employers will be faced with the question of how to respond when an employee tests positive, or has exposure to the coronavirus, and will need to determine when those employees can safely return to work.  In part, it depends on whether the employee has simply tested positive, or if the employee tests positive and has symptoms. Where an employee has tested positive for COVID-19, but has no symptoms, the employee can return to work 10 days after the first positive test. Where an employee has tested positive for COVID-19 and has symptoms, the employee may safely return to work at least 10 days after the onset of symptoms, at least 24 hours have passed since resolution of fever without the use of fever-reducing medications, and all other symptoms have improved.  All three criteria must be met before the employee can safely return to work.    For employees with severe illness, 20 days of isolation after symptom onset may be warranted. Once a company has ensured that an employee with a confirmed or suspected COVID-19 case will not be reporting to the business’ physical worksite, Pennsylvania employers must take the following steps: I. Secure and Decontaminate Affected Areas Close off areas visited by the person who is a probable or confirmed case of COVID-19. Wait at least 24 hours, or as long as practical, before cleaning and disinfecting the affected area. If more than seven days have passed since affected person visited the business or facility, enhanced cleaning and disinfection is not necessary. Open outside doors and windows and use ventilation fans to increase air circulation. Clean and disinfect all shared areas such as offices, bathrooms, break rooms, shared electronic equipment (printers, touch screens, keyboards, remote controls) used by the affected person. For more information, see https://www.governor.pa.gov/covid-19/business-faq/ Read More