As we have discussed in an earlier blog post, the federal administrative agencies have been placing greater emphasis on being more transparent and promoting “interoperability”.
As such, on April 24, 2018, the Centers for Medicare & Medicaid Services (“CMS”) proposed changes to its Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System to promote better access to
Continue Reading Seeking Interoperability: Centers for Medicare & Medicaid Services
CMS has published a Proposed Rule to clarify how physicians are to bill for services furnished “incident to” the professional services of a physician.
When a medical practice bills Medicare “incident to” for NPP services (i.e. “non-physician practitioners” such as nurses or physician assistants), the bill is rendered by the physician using the physician’s NPI number. Incident to services billed
Continue Reading ‘Incident To’ Billing: Billing Physician as the Supervising Physician and Ancillary Personnel Requirements
When does the 60-day clock start for an identified overpayment of federal funds to become a reverse false claim under amendments to the False Claims Act? A closely watched SDNY qui tam case may provide an answer.
In June, the United States and New York intervened in United States v. Continuum Health Partners, Inc., alleging that defendants had knowingly
Continue Reading Dismissal Motions Filed In SDNY Computer Glitch Reverse False Claim Act Case
At the end of June, the U.S. Attorney’s Office in Manhattan filed a False Claims Act complaint against Beth Israel Medical Center, St. Luke’s-Roosevelt Hospital Center, and Continuum Health Partners, United States v. Continuum Health Partners, Inc., alleging that defendants had knowingly failed to return overpayments owed to Medicaid arising out of a computer glitch.
A recent SDNY False Claims Act decision provides strong support for the argument that a false claim may not be based on conduct that follows federal or state rules and guidelines.
In United States ex rel. Doe v. Taconic Hills Central School District, relators alleged that the New York City Department of Education (“DOE”) and several school districts submitted
Continue Reading False Claims Act Complaint Dismissed Where Defendant Followed State Regulations
At the end of January, the Office of Inspector General for the Department of Health and Human Services (“HHS-OIG”) released its 2014 Work Plan. The Work Plan summarizes new and ongoing reviews and activities that HHS-OIG plans to pursue with respect to HHS programs and operations in the coming year. Senior HHS-OIG officials outlined agency goals in a video
Continue Reading HHS-OIG 2014 Work Plan Focuses On Health Insurance Transitions
In U.S. ex rel. Wolfson v. Park Avenue Medical Associates, the U.S. Attorney’s Office in the Southern District of New York entered into a $1 million False Claims Act settlement against three related companies for improperly billing Medicare for behavioral health services. The settlement agreement provided that the defendants “admit, acknowledge and accept responsibility for” (1) billing Medicare for
A bill proposed in the US House of Representatives may cause physicians to significantly restructure their practices as they relate to in-office ancillary services (IOAS).
Promoting Integrity in Medicare Act of 2013
The Stark Law is a federal statute which prohibits physicians from making referrals for Medicare-covered designated health services (DHS) to an entity with which the physician or an
Continue Reading Bill Could Narrow Stark Law Exception for In-Office Ancillary Services
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 each may end up killing
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 vouchers, tax credits, and Health
Continue Reading Are Mandatory Price Controls the Answer to America’s Health Care Woes?