Removing Ambiguity from CMS’s In-Home HRA Guidance: Lessons from Cigna’s $172 Million False Claims Act Settlement

December 22, 2023 | By: Edward Baker, Of Counsel | Lieff Cabraser Heimann & Bernstein On September 30, 2023, the U.S. Department of Justice announced a $172 million False Claims Act (FCA) settlement with Cigna relating to the submission of invalid HCC diagnosis codes to CMS in order to increase Medicare Advantage member risk scores, and therefore,…

How Laboratories Rendering Anatomic Pathology Services Can Comply with AKS

  November 17, 2023 | By Amanda Waesch This past September 2023, the Office of Inspector General for the U.S. Department of Health and Human Services (OIG) issued Advisory Opinion 23-06 (AO).1 The Opinion involved a proposed arrangement between an independent pathology laboratory and third-party physician laboratories for the purchase of the technical component of…

When Interpreting Ambiguous Federal Healthcare Laws, Practice “Safe Driving”

  September 15, 2023 | By: Edward Baker, Of Counsel | Lieff Cabraser Heimann & Bernstein If you lie awake at night worrying about whether your coding, auditing, or compliance practices might be based on misinterpretations of federal law, opening up your healthcare employer—or yourself!—to treble damages and penalties under the False Claims Act (FCA), you may…

Justice Served

Strategic Litigation Services | CEMA Certification | Audit Services Details of the Case From Expert Witness Sean M. Weiss Recently, Sean M. Weiss with NAMAS’ parent company DoctorsManagement testified as an expert witness in a federal court case against four healthcare providers in one of the largest Medicare/Medicaid fraud cases in U.S. history. Read below as Sean recaps…