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Articles Posted in HLP News and Events

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Recent Increase in NCI ZPIC Audit Activity

In the last few weeks, we have seen a flurry of activity in Zone Program Integrity Contractor (“ZPIC”) audits for the Centers of Medicare and Medicaid Services (“CMS”). Recently, many providers – and home health agencies, in particular – have received ZPIC audit notifications from NCI, Inc. (“NCI”) In April…

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Florida Compounding Pharmacy Settles False Claims Act Allegations Involving Telemedicine Prescriptions for $8 Million

On July 15, 2015, the U.S. Attorney’s Office for the Middle District of Florida announced that it settled False Claims Act allegations against Blanding Health Mart Pharmacy for more than $8 million. Blanding Health Mart Pharmacy is a compounding pharmacy based in Jacksonville, Florida. The settlement stems from allegations that…

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Moratoria on Enrollment of Ambulance Suppliers and Home Health Agencies Extended

On July 29, 2015 the Centers for Medicare & Medicaid Services (“CMS”) announced that it is extending the temporary moratoria on the enrollment of new home health agencies, subunits, and branch locations (“HHA”) and part B ambulance suppliers for an additional six months. Section 6401(a) of the Affordable Care Act…

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OIG Scrutinizes Overlap Between Physician-Owned Hospitals and Physician-Owned Distributors

The government does not like Physician-Owned Hospitals (“POH”). The government also does not like Physician-Owned Distributors (“POD”). The Centers for Medicare and Medicaid Services (“CMS”) and the Office of Inspector General (“OIG”) have taken several steps recently to crack down on what it views as abusive PODs and POHs. In…

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OIG Issues Two Reports on Fraud and Abuse in Medicare Part D

In June, the Office of Inspector General (“OIG”) issued two new reports on Medicare Part D titled: Ensuring the Integrity of Medicare Part D (available here) and Questionable Billing and Geographic Hotspots Point to Potential Fraud and Abuse in Medicare Part D (available here). In the Ensuring the Integrity of…

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Major Stark Provisions in 2016 Proposed Medicare Physician Fee Schedule

On July 8, 2015, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule containing major provisions relating to the Physician Self-Referral Law (i.e., the Stark Law) and its exceptions. CMS states that the purpose of the Stark proposals is: “to accommodate delivery and payment system reform, to…

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OCR Announces Consolidation of Kansas City and Chicago Branches

On April 20, 2015, the Department of Health and Human Services’ Office of Inspector General, in partnership with the American Health Lawyers Association and the Association of Healthcare Internal Auditors, published Practical Guidance for Health Care Governing Boards on Compliance Oversight, which describes the OIG’s expectations of the compliance oversight…

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Proposed Legislation Would change Michigan CRNA Supervision Requirements and Increase Access to Anesthesia Care

On May 7, 2015, Michigan Senator Mike Kowall (R-White Lake) introduced legislation that would allow hospitals more flexibility in determining the best anesthesia delivery model for their patient’s needs. While certified registered nurse anesthetists (“CRNAs”) provide the anesthesia care during most patient procedures – staying with the patient throughout the…

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HHS Proposed Rules Would Expand Authority to Exclude Providers and Impose Monetary Penalties

On May 9 and May 12, 2014, the United States Department of Health and Human Services (“HHS”) published two proposed rules that would significantly expand the authority of the Office of Inspector General (“OIG”) to exclude providers from participation in federal health care payor programs and impose civil monetary penalties.…

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CMS Considering Potential Alternatives to “Two-Midnight Rule”

On May 19, 2014, Centers for Medicare and Medicaid Services (“CMS”) announced that it is considering new ways to define and pay for hospital short-stays. In October 2013, CMS implemented the “Two-Midnight Rule” with the goal of bringing clarity to billing for Part A inpatient hospital admissions. However, the Rule…