In an opinion issued March 30, 2012, the United States Court of Appeals for the Fourth Circuit overturned a $45 million judgment against Tuomey Healthcare System, Inc. (“Tuomey”), a private, nonprofit corporation which owns and operates Tuomey Hospital in Sumter County, South Carolina. A former physician brought a qui tam…
On March 27, 2012, the Office of Inspector General (“OIG”) posted a favorable, but narrowly defined, Advisory Opinion (Opinion No. 12-02) pertaining to Requestor’s proposal to operate a website that would display coupons and advertising from health care providers, suppliers, and other entities (the “Proposed Arrangement”). Under the Proposed Arrangement,…
The HLP Women in Healthcare networking events are spearheaded by the women healthcare partners of The Dresevic, Iwrey, Kalmowitz & Pendleton Law Group, a division of The Health Law Partners. The events provide an informal forum for women in all aspects of the healthcare industry to network with their peers;…
The Health Law Partners is pleased to announce that four of our partners – Robert Iwrey, Alan Gilchrist and Dan Brown – have been awarded AV Preeminent ratings by Martindale-Hubbell (the highest rating available) in recognition of their high level of professional skill and integrity. The ratings reflect a combination…
According to a Department of Justice press release, on Thursday March 15, 2012, a man residing in Dearborn Heights, Michigan was charged by Criminal Complaint with health care fraud. 51-year-old Fitzgerald Anthony Hudson was arrested, and could face a maximum penalty of 10 years imprisonment and a fine of $250,000.…
In a Study released March 15, 2012, the Department of Health and Human Services, Office of Inspector General (OIG), reported on what it determined to be questionable billing by Independent Diagnostic Testing Facilities (IDTFs) for claims submitted in 2009. In conducting this study, the OIG analyzed claims among geographic areas,…
Medicare released new guidelines regarding the limit on the number of additional documentation requests (“ADRs”) RACs may request per 45-day period. Notably, these revisions constitute an increase for providers. (Note: the revised ADR limits outlined below do not apply to physicians and suppliers.) Effective March 15, 2012, the ADR limits…
The Acting Administrator of the Centers for Medicare & Medicaid Services (CMS), Marilyn Tavenner, announced the redesign of the statement that informs Medicare beneficiaries about their claims for Medicare services and benefits. The announcement comes as a part of National Consumer Protection Week. The redesigned statement, known as the Medicare…
Effective January 1, 2012, Highmark Medicare Services (“Highmark”) was acquired by Diversified Service Options, Inc. (a wholly-owned subsidiary of Blue Cross and Blue Shield of Florida, Inc.). As a result of the acquisition, Highmark changed its name to Novitas Solutions, Inc. (“Novitas”). Novitas will continue Highmark’s role as the Medicare…
On February 23, 2012, CMS issued an email notification to all Fee-for-Service (“FFS”) providers, which states the following: CMS has received reports that providers are receiving denials for advanced diagnostic imaging (ADI) services they are accredited to perform. We have taken action to correct the situation. CMS has instructed all…