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Williamson Health Law has been recognized as one of the 2022 “Best Law Firms” by U.S. News & World Report and Best Lawyers®.

Williamson Health Law is ranked Metropolitan Tier I-Detroit in Health Care Law. This is the seventh consecutive year Williamson Health Law has been ranked by Best Lawyers®.

Firms included in the 2022 “Best Law Firms” list are recognized for professional excellence with persistently impressive ratings from clients and peers. Receiving a tier designation reflects the high level of respect a firm has earned among other leading lawyers and clients in the same communities and the same practice areas for their abilities, their professionalism and their integrity.

Deborah J. Williamson, Founder and Managing Partner of Williamson Health Law, is also listed in The Best Lawyers in America® 2022. Ms. Williamson has been featured in the Best Lawyers listings since 2013.

There are no balloons, handshakes or smiles when the Office of the Inspector General at the U.S. Department of Health and Human Services welcomes new physicians. There is instead a dry, fairly formal listing of “the five most important Federal fraud and abuse laws that apply to physicians”:

• False Claims Act
• Anti-Kickback Statute
• Physician Self-Referral Law (Stark law)
• Exclusion Authorities
• Civil Monetary Penalties Law

“As you begin your career, it is crucial to understand these laws not only because following them is the right thing to do, but also because violating them could result in criminal penalties” and more, the OIG says. The “more” includes fines, exclusion from Medicare and Medicaid and the loss of your medical license.

The OIG notes that it’s illegal to submit claims to Medicare or Medicaid that you know – or should know – are false or fraudulent. Penalties for violating the False Claims Act can mean fines of up to three times the amount the programs lost due to your false claims, plus $11,000 per claim you filed.

That means that if Doctor A filed 100 false Medicare claims for $1,000 each, the loss to that program would be $100,000. That means Doctor A could be fined up to $300,000, plus an additional $1,100,000 for his violations.

If Doctor A’s false claims were the results of kickbacks or were made in violation of the Stark law, there can be additional liability under the Anti-Kickback

Federal prosecutors and law enforcement agents continue to show that they place allegations of Medicare fraud high on their list of priorities.

The U.S. Attorney’s office in the Western District of Michigan has announced the results of a Medicare fraud sting called “Operation Happy Clickers”, which has resulted so far in civil suits against three Michigan doctors and a guilty plea by a nurse practitioner. The name of the operation refers to the speed at which the involved medical professionals clicked on and approved prescriptions with little or no review. The prescriptions at issue were for various medical equipment and genetic tests that were not actually medically necessary.

The US Attorney’s Office said the actions resolved allegations of Medicare fraud that totaled $7.3 million.

Operation Happy Clickers follows nationwide arrests in 2019 and 2020 of what were called large-scale Medicare fraud schemes involving telemarketers, durable medical equipment supply company owners and cancer genetic testing labs.

In the recent Michigan case, telemarketers (often in overseas call centers) contacted Medicare recipients to sell them medically unnecessary tests and devices. The marketers then allegedly paid healthcare professionals to sign device and test orders. Then the telemarketers allegedly sold the approved orders to companies that supply devices and labs that

We’re proud to announce that Williamson Health Law founder and managing partner Deborah J. Williamson has been named one of the Best Lawyers in America in the Health Care Law category.

The accolades don’t end there, however. Because of the “extremely high voter feedback” from her peers, Ms. Williamson has also been named 2022 “Lawyer of the Year” for Health Care Law in Detroit.

Only one attorney in each practice area and community can receive the “Lawyer of the Year” award.

“Recognition by Best Lawyers is based entirely on peer review,” the company says on its website.

The recognition process begins with a nomination. Anyone can make a nomination, but Best Lawyers says only attorneys can give the “meaningful and substantive evaluations of the quality of legal services” that determine who will be honored.

After the peer review process concludes, Best Lawyers reviews the feedback and then checks to make sure that candidates are in good standing with the applicable bar association.

Later, the company notifies the attorneys who have sufficient peer approval to be recognized as among the Best Lawyers in America.

Those candidates who receive “the highest overall peer-feedback for a specific practice area and geographic region” receive even higher recognition as Lawyer of the Year.

We’re proud that Attorney Williamson continues to earn the respect of

Last year, the United States spent more than $700 billion to provide Medicare benefits for people age 65 and above. It is important for Michigan physicians and health system management to understand that an investment of that size is going to be protected by federal law enforcement agencies.

One of their most powerful protection tools is the Anti-Kickback Statute, which prohibits paying, offering, soliciting or receiving compensation to induce patient referrals for services covered by Medicare, Medicaid or Tricare.

Another powerful tool: whistleblower lawsuits filed by private citizens on behalf of the government involving allegations of fraud against federal programs such as Medicare. The plaintiff can be entitled to a portion of a settlement resolving the matter.

The Department of Justice recently settled a whistleblower lawsuit for what “appears to be the largest settlement in a case brought against a hospital for kickbacks paid to a single physician,” an attorney representing the plaintiff said.

According to a MedPage Today report, Prime Healthcare, its CEO and a cardiologist employed by the California-based health system will pay $37.5 million to settle a whistleblower lawsuit that alleged kickbacks and fraudulent medical billing.

Prime Healthcare CEO and founder Prem Reddy, MD, and the system he headed allegedly arranged in 2015 to buy

Williamson Health Law is pleased to announce that firm founder and managing partner Deborah J. Williamson has been named to the 2021 Michigan Super Lawyers list in the Health Care Law category.

Super Lawyers annually rates outstanding attorneys in each state in more than 70 practice areas.

Attorneys with high levels of peer recognition and professional achievement can be nominated by either fellow lawyers or by attorney-led research teams.

A dozen criteria are then used to evaluate nominees, including experience, verdicts/settlements, education, pro bono work/community service, special licenses/certifications and professional honors and awards.

With more than two decades of experience representing health care providers in legal and compliance matters, Ms. Williamson is respected by clients and peers alike.

She regularly speaks and writes on important health care law topics such as the Stark Law, HIPAA, regulatory compliance plans and post-payment audits.

She also serves on the Council of the State Bar of Michigan’s health care law section and is a member of the American Health Law Association.

Ms. Williamson graduated magna cum laude from the Michigan State University College of Law in 1997 and was honored as one of the legal profession’s Rising Stars in 2011-12.

Regular readers of our Michigan Health Care Legal Blog will undoubtedly recall a recent post detailing potential pitfalls for physicians on social media. The post included useful information about going viral, violating patient privacy and advice for how to deal with patients’ “friend” requests on Facebook.

In this post, we’ll delve into the dispensing of specific medical advice, and making unprofessional comments and posting photos of unprofessional behavior on social media.

When you post general comments about treatments or conditions, there will often be responses asking for advice about their specific case. A reply or back-and-forth comments could be a HIPAA violation. It’s also possible that a reply could be construed as a physician-patient relationship.

The doctor who wrote a Medscape article about social media advised physicians who get requests for advice to urge the person to visit your practice.

It might also be a good idea to include on your social media pages a boilerplate statement that you won’t comment on social media on any individual’s specific case.

There are doctors who have made unprofessional comments or shared photos of unprofessional behavior on social media platforms. They don’t seem to understand that patients and employers can view the posts and that there can be serious consequences for flaunting unprofessional

Social media is as ubiquitous for Michigan physicians as it is for everyone else. Some people wake up to Twitter and go to sleep with Facebook. In between, they steal away moments with Snapchat, Instagram, Reddit, Pinterest and others.

Doctors need to be especially careful on social media, always mindful of protecting patient privacy and when sharing medical information, always presenting absolutely correct info.

Some physicians stay away from social media because of its risk of potential disaster. But a California doctor wrote in Medscape that you don’t need to abandon social media. You simply need to exercise discretion and understand its risks.

Social media amplifies your words and images. A stray comment can go viral and reach hundreds of thousands of people (and even more). Mistakes and misstatements are difficult to undo. You can take down an ill-advised Facebook comment and delete a cringe-worthy tweet, but both can live on after being shared or in screenshots.

Think through your comments before posting them. There can sometimes be a heavy price to pay for being clever, bold or controversial.

Social media has a nearly infinite supply of opportunities for doctors to violate patient privacy. Examples: citing patients’ cases on the practice’s website, crowdsourcing a patient’s diagnosis with colleagues and posting photos that inadvertently reveal a

We read recently of a radiation therapy provider that agreed to pay more than $3.5 million in a CMP (civil monetary penalty) settlement with the OIG (Office of Inspector General).

According to the settlement, the company submitted claims for radiation and oncology services that:

• Used incorrect CPT codes and service dates
• Weren’t provided
• Didn’t include sufficient documentation to support service necessity
• Were “unbundled”
• Contained “incomplete documentation”

In general, the AMA says, medical billing errors fall into one of two broad categories: fraud or abuse.

The AMA’s “Principles of CPT Coding” offers definitions of the terms: Fraud “involves intentional misrepresentation,” while abuse means “the falsification was an innocent mistake, but nonetheless representative.”

The organization also lists some common medical-coding errors to avoid:

• Unbundling codes: the AMA says providers should use the single code “that captures payment for the component parts of a procedure.” Don’t unbundle to increase payments.
• Upcoding: consequences for this can be “severe.”
• Failing to check NCCI edits before reporting multiple codes
• Failure to append appropriate

In some industries, it’s not only legal to reward someone who refers business, it’s considered good form to do so. Healthcare is not one of those industries, however. It’s a crime for healthcare practitioners to take anything of value in return for a referral, order or prescription when the goods or services are paid for by Medicare, Medicaid or any other part of the federal government.

Many Detroit-area healthcare providers undoubtedly recall that in 2019, Beaumont Health agreed to settle allegations that it violated the Anti-Kickback Statute by making payments to physicians who made referrals to its William Beaumont Hospital in Royal Oak.

The health system was also accused of violating the Stark Law, or self-referral law, which prohibits hospitals from billing Medicare for services referred by physicians with whom the hospital has a financial relationship.

Beaumont Health agreed to pay $82.74 million to the federal government and another $1.76 million to the state of Michigan.

Another application of the Anti-Kickback law can be found in the recent settlement of the CareCloud Health case. The Florida-based developer of EHR (electronic health records) “agreed to pay $3,806,966.70 to resolve allegations that it paid unlawful kickbacks to generate sales of its EHR products,”

The constantly evolving U.S. healthcare system imposes a variety of challenges on Michigan providers. Frequent changes to compensation models and billing regulations can result in billing errors that sometimes result in uncollected revenue and sometimes result in insurer overpayments and investigations of possible healthcare fraud.

The Association of Certified Fraud Examiners (ACFE) has on its website a list of health care provider fraud schemes compiled by veteran Certified fraud examiner and private investigator Charles Piper.

Certified fraud examiner and private investigator Charles Piper says that in almost every healthcare fraud investigation he’s conducted, he has found evidence that the provider submitted claims to Medicare, Medicaid or an insurance company for care that was never provided and that patient files had no supporting documentation.

Billing for services not rendered, he says, is “real easy money.”

Piper says though he understands that records can be lost or misplaced, “a pattern of billing for services and care with no supporting documentation is unacceptable and unlikely to be coincidental.”

In addition to examining documentation, fraud investigators conduct interviews with staffers and patients listed in claims.

While physician impersonation is pretty rare, this form of misrepresentation of

Like other medical professionals, chiropractors are aware of the significant benefits to patients when health care is provided by a medically integrated practice.

“Medical errors are minimized, unnecessary tests avoided, prescription painkillers reduced,” chiropractor Jesse Cooper told the American Chiropractic Academy in 2019.

However, there are strict services and billing guidelines to be observed and potentially serious legal consequences when integrated practices are not set up properly, according to a recent article by chiropractor and medical compliance officer, Ray Foxworth.

He writes in the current issue of Chiropractic Economics that a multidisciplinary medical practice should assume that audits will take place and prepare accordingly.

Chiropractor Mark Sanna – who also authored a piece in CE – writes that medically integrated practices should “retain local legal counsel familiar with the group practice health care laws and regulations of the state in which the practice will be established.“

Sanna notes that “while successfully operating a MDP can be rewarding, those rewards can quickly disappear should the chiropractor and other professionals involved not adhere to the most stringent policies and procedures.”

Foxworth writes that medically integrated practices “must be aware” of the federal Anti-Kickback Statute that forbids

Tom Cruise’s “Mission Impossible” film series was launched back in 1996. Every few years since, new “MI” movies have updated the franchise while sticking to its core action-intrigue values.

Also debuting that year: Health Insurance Portability and Accountability Act (HIPAA). While many in the healthcare industry believe the federal law protecting sensitive patient health information needs to be modernized, there are provider group concerns about the following:

• The privacy and security of sensitive medical data when it’s made more accessible
• Implementing changes during a pandemic
• Squaring the changes with other data-restricting regulations

The American Medical Association stated in a letter to OCR that it questions “the need for these changes, particularly at this time.”

The physician group noted that practices still face major challenges to alter IT and data exchange processes in order to comply with last year’s rules changes promoting interoperability. And of course, there’s ongoing pandemic-related overhead to contend with as well.

“We urge OCR to reconsider implementing a massive change to patient privacy laws in the midst of this transition,” the AMA wrote.

If finalized,

The potential for abuse and addiction involving controlled substance medications makes it of paramount importance for doctors, pharmacies, hospitals and other health care providers to comply with laws and regulations enforced by the federal government’s Drug Enforcement Administration (DEA).

Providers that administer and dispense controlled substance medications have dealt with unprecedented challenges over the past year, but the challenge to be DEA-compliant remains unchanged. However, the agency has issued guidelines related to pandemic-specific vaccines and other matters that add to the compliance burden.

Here are areas of concern for providers to be aware of as we all continue to make our way through this public health crisis.

Because of the rapid expansion of telemedicine during the pandemic, practitioners are authorized to prescribe certain controlled substance medications without in-person evaluations. Of course, those prescriptions must all be for legitimate medical purposes and issued in compliance with pertinent state and federal laws.

Registered providers are temporarily allowed to supply other registered providers with more than five percent of their dosage units. The DEA expects providers to be aware of when the exception expires. (Note: it expires when the public health emergency ends or the DEA modifies the

As many readers of our Michigan legal blog know, the Medicare audit appeals process has relatively small timeframes in which providers can object to claims of overpayments.

The good news for a Las Vegas hospital recently audited by the Office of the Inspector General is that its initial timely response to an audit meant that it was able to reduce the amount the OIG wants refunded for Medicare billing errors by $8,914. The reduction followed Sunrise Hospital & Medical Center’s submission of a handful of claims for reprocessing.

The bad news is that the Health and Human Services (HHS) watchdog insists on the return of the remaining portion of what it claims is $23.6 million in overpayments resulting from Medicare billing errors.

The OIG reviewed 100 inpatient and outpatient claims for the audit period from Jan. 1, 2017, through Dec. 31, 2018.

The OIG said Sunrise “complied with Medicare billing requirements for 46” of the reviewed claims, but “did not fully comply” on “the remaining 54 claims, resulting in net overpayments of $999,950 for the audit period.”

The federal office said 50 inpatient claims and four outpatient claims contained billing errors.

On the basis of the sample results, OIG estimated that Sunrise “received overpayments of at least $23.6 million for the audit period.”

In a statement on the hospital’s website, the Sunrise CEO said, “We strongly disagree

HIPAA was written to protect individuals’ personal health information. Because HIPAA applies to doctors, hospitals, health plans and insurers, dentists, pharmacies, nursing homes, urgent care clinics and other entities paid to provide health care, many in the health care industry wonder if a vaccine passport would violate HIPAA.

Let’s say an airline required passengers to show a vaccine passport containing protected health information before boarding a plane. Because the airline isn’t a health care provider, experts say that HIPAA wouldn’t apply to passengers’ voluntary sharing of information about themselves.

Of course, airlines would still have to comply with Michigan privacy laws and applicable laws in other states.

Other nations – including China, Japan and those in the European Union – are working on their own versions of digital vaccine passports, Detroit’s PBS station WTVS reported.

The Biden administration recently said it won’t pursue the creation of a federal vaccine passport for use in travel or businesses. However, the administration also said it would help states to develop their own.

Critics of vaccine passports say the documents could jeopardize private health data and personal freedoms.

It should be noted that for decades, travelers to certain parts of Africa

There are at least a couple of ways to view state medical boards that don’t issue many serious disciplinary actions for physicians. One way is to assume that because the rate of serious disciplinary actions per 1,000 licensed physicians in the state is low, nearly all of the doctors in the state are less likely to be professionally inadequate or engaged in criminal activities than physicians in other states.

That isn’t how the consumer advocacy group Public Citizen views things, however. The nonprofit organization says many state medical boards “are doing a dangerously lax job” of protecting the public.

Public Citizen recently issued a report ranking states by their rates of serious disciplinary actions per 1,000 licensed doctors in each state from 2017 to 2019.

Michigan ranks as the fourth most aggressive with 1.70 serious actions per 1,000 physicians, trailing only Kentucky (2.29), Arizona (1.81) and Pennsylvania (1.78).

The most lenient were Georgia, New Hampshire and the District of Columbia, with 0.32, 0.32 and 0.29 serious actions per 1,000 doctors, respectively.

Public Citizen uses disciplinary actions by medical boards as a measure of how well each state protects patients. “There is no reason to believe that physicians in any one state are more or less likely to be incompetent or miscreant than the physicians in any other state,” the organization stated in its report.

According to a news

One of the many changes the pandemic has compelled society to make is telehealth. The rapid rise of telehealth in the year-plus of the pandemic has made healthcare services more accessible, helped preserve personal protective equipment, reduced demand on healthcare facilities and helped to keep both patients and providers free of the virus.

Earlier this year, the Deputy Director for the Health and Human Services Office of Inspector General said telehealth isn’t just a matter of convenience for Medicare beneficiaries, it’s also “a matter of safety for many beneficiaries.”

Because many healthcare providers are saying they expect that telehealth will continue after the pandemic – and could even expand – the OIG Deputy Director announced plans to conduct “significant oversight” of telehealth to ensure its benefits aren’t compromised by abuse, misuse or fraud.

In fact, the OIG is already in the process of conducting several audits involving telehealth services. While the OIG’s work plan (a work plan is a list of “audits, evaluations, and inspections that are underway or planned”) indicates the focus will be on healthcare industry trends that emerged in the course of the pandemic, audits could also identify providers it believes received Medicare overpayments.

For instance, the OIG is conducting audits on the “Use of Telehealth to Provide Behavioral Health Services in Medicaid Managed Care,” “Home