In late October the U.S. Attorney’s Office in the Southern District of New York announced the settlement of a False Claims Act case against Westchester Medical Center (“WMC”) for $7 million, for submitting false reimbursement claims to Medicaid from August 2001 through June 2010 involving outpatient behavioral health services. The settlement is to be
Disaster Recovery Advisory
Some of our colleagues at Farrell Fritz prepared an advisory with helpful information and links for families, individuals and businesses in need of disaster recovery assistance due to Hurricane Sandy or the subsequent storm.
We hope you weathered the storms safely. Please do not hesitate to contact us if we can be of assistance in
Electronic Health Records Come Under OIG Scrutiny
The Health Information Technology for Economic and Clinical Health Act (the “HITECH”) Act of 2009 aims to have all hospitals and physicians use electronic health records (“EHRs”) for all persons in the United States by 2014. Federal and State financial incentives, electronic billing requirements, and the need for ever-increasing collaboration and sharing of information among
Is Medicare Fee for Service Dead?
A post on the KevinMD blog written by Bob Doherty, Senior VP of the American College of Physicians, says that regardless of who wins the 2012 Presidential election, the fee-for-service payment methodolgy to physicians under Medicare may be dead.
The health reform proposals from President Obama and Governor Romney approach Medicare from different angles, but
Are Mandatory Price Controls the Answer to America’s Health Care Woes?
In this election season, both presidential candidates offer plans to deal with the rising cost of providing health care services, the President’s “Obamacare” by increasing the number of insured individuals through Health Insurance Exchanges, and reducing costs for a continuum of services through Accountable Care Organizations; and Governor Romney by a consumer-driven approach through Medicare
OMIG to Withhold Payments for “Credible Allegations of Fraud”
The New York State Office of the Medicaid Inspector General (“OMIG”) recently finalized regulatory changes to New York State law which relate to the withholding of payments to Medicaid providers when there is a “credible allegation of fraud.” A credible allegation of fraud is defined as an “allegation that has indicia of reliability and has
Health Systems as Providers and Insurers
Historically, health care services have been paid for by health insurance companies which accept monthly premium payments from employer groups and individuals. The premium for defined health care services is due whether the insureds under the policy use the benefits or not. Built into the premiums are additional administrative costs including fees paid to insurance
The False Claims Act and Federal Grants
In United States ex rel. Feldman v. van Gorp , decided last week, the Second Circuit ruled on an issue of first impression concerning False Claims Act (“FCA”) damages in the context of a federal grant for medical research funding, and also addressed the FCA’s materiality standard.
In Feldman, Cornell University and a psychiatry
Accountable Care and Collaboration Among Providers
In order for an accountable care organization to succeed, there must be a workable method for collaboration among the providers. How do providers of care effectively communicate amongst one other? What is the optimum means of memorializing a patient’s medical history and present health status so that all providers of care are basing their decisions
CMS to Penalize Hospitals Under Hospital Readmissions Reduction Program
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