Lawrence Vernaglia on Provider-Based Billing Settlement – 'Underscores the risks hospitals face'

Foley & Lardner LLP partner Lawrence Vernaglia commented in the Report on Medicare Compliance article, “After Self-Disclosure, Hospital Settles Case Over Provider-Based Billing,” published by the Health Care Compliance Association.

Discussing a recent settlement by a medical center to settle allegations that it violated the False Claims Act in connection with Medicare overpayments and physician financial arrangements not in compliance with the Stark Law, Vernaglia said the settlement underscores the risks hospitals face when it comes to provider-based billing (PDP) compliance.

These risks include PDP relocation, which Vernaglia thinks is “ripe for a challenge” following the U.S. Supreme Court’s ruling in Loper Bright Enterprises v. Raimondo in June 2024.

“There’s nothing in the statute that gave them the authority to impose site neutrality for services that were in facilities that predated the 2015 deadline,” he explained, referencing the change Congress made in billing rules in Section 603 of the Bipartisan Budget Act of 2015. “And the relocation and expansion prohibitions are similarly infirmed under the Loper Bright holding.”