A 1995 court decision involving Caremark established that members of boards of directors likely have liability for non-compliance with fraud and abuse prohibitions. A recent Court decision likely extends liability to individual corporate officers.

Compliance with HIPAA can be complex. Examples of violations, or “HIPAA stories,” may make requirements more understandable. Here are some of those stories.

To prove that providers rendered negligent wound care, patients must prove all of the following: Duty, breach, cause, and injury or damage.

Although the trend is certainly against non-compete agreements or restrictive covenants in the health care industry, some state courts have affirmed their use.

The owner of a supplier of home medical equipment (HME) complained that her company did not receive referrals from TidalHealth Nanticoke Hospital. The Court dismissed the owner’s lawsuit because she could not prove her claims. This case illustrates why providers who complain about practices of referral sources must have facts to support their claims. 

Discharge planners, case managers, and social workers certainly cannot accept cash payments from providers in exchange for referrals of patients. But what can they accept from providers who want referrals?

In a November 2021 decision, the U,S, Court of Appeals said that CMS can recoup overpayments from providers even though its appeals are still pending before Administrative Law Judges.