The Centers for Medicare & Medicaid Services (“CMS”) will be penalizing more than 2,000 hospitals nationwide starting in October 2012 under the Hospital Readmission Reduction Program (the “Program”). A number of New York hospitals were included on the list of hospitals to which CMS will apply the readmission penalty to reimbursements, including Beth Israel Medical
Medicare Issues in Bankruptcies
In its August 2012 issue, the American Bankruptcy Institute Journal published Medicare Issues in Bankruptcies by Ted Berkowitz and Veronique Urban of Farrell Fritz.
The takeaways:
-Health care entities contemplating a bankruptcy filing should carefully consider the effects that the filing will have on their Medicare arrangements;
-Health care debtors should be aware that any
Feds Release HIPAA Audit Protocol
The US Department of Health and Human Services Office of Civil Rights (“OCR”) recently released its HIPAA audit protocol. Audits of HIPAA compliance were mandated by the 2009 Health Information Technology for Economic and Clinical Health (“HITECH”) Act, which amended many parts of HIPAA and included breach notification requirements.
The OCR conducted a number of
Affordable Care Act: Bundling Payments to Control Costs
Now that the Affordable Care Act has been upheld by the U.S. Supreme Court, the requirement to control costs is critical. One thing we can learn from the experience of near universal coverage in Massachusetts is that providing access to more citizens without containing costs is a recipe for disaster. In 2006 Massachusetts achieved coverage
NYS Office of the Medicaid Inspector General Releases Compliance Guidance for Hospitals
The New York State Office of the Medicaid Inspector General (“OMIG”) recently released its Compliance Program Guidance for General Hospitals. While the OMIG had previously released a Compliance Program Assessment Tool, the new Guidance document provides a far greater level of detail as to the expectations of a hospital’s compliance program.
New York State
Hospital-Physician Contracts Lead to Stark Violation
The recent decision in United States ex. rel. Drakeford v. Tuomey Healthcare Sys. Inc., No. 10-1819 (4th Cir. Mar. 30, 2012) provides a sobering reminder that hospital-physician contracts should be drafted carefully in order to avoid containing any provisions that could inadvertently result in Stark law liability.
Subject to certain limited exceptions, the federal
False Claims Act Settlement Requires Admission of Conduct
The U.S. Attorney’s Office for the Southern District of New York recently announced the settlement of a health care False Claims Act case against Beth Israel Medical Center for fraudulently inflating its fees for services provided to Medicare patients in order to obtain larger “outlier payments.” Beth Israel agreed to pay over $13 million to
Medicare Publishes 60-day Repayment Rule
The 2010 Patient Protection and Affordable Care Act (“PPACA”) imposed an obligation upon Medicare providers, including physicians, hospitals, nursing homes and home health agencies, to report and return any overpayments they receive within 60 days of identification of the overpayment. Failure to do so could result in substantial penalties to the provider under the False
Federal Court Rules on Qui Tam Issue
In a recent Southern District of New York decision, Judge Jed S. Rakoff examined the original source exception to the False Claims Act’s (“FCA”) public disclosure bar. In United States ex rel. Associates Against Outlier Fraud v. Huron Consulting Group, Inc., 2012 WL 506824 (S.D.N.Y. Feb. 16, 2012), the relator alleged that defendant Huron
Hospital Wins Right to Private Action in Prompt Pay Matter
A recent decision in the Supreme Court, Kings County, has confirmed that health care providers have a private cause of action under N.Y. Insurance Law § 3224-a (the “Prompt Pay Law”).
In Maimonides Med. Ctr. v. First United Am. Life Ins. Co., 2012 NY Slip Op. 22039 (decided February 22, 2012), the Court determined