Until October 2009, physicians could lawfully act as service providers to hospitals by furnishing their services “under arrangements” where a physician or group of physicians would provide services, equipment and supplies to a hospital’s patients by contracting with the hospital to provide the services. Urologists, for instance, regularly furnished lithotripsy…
The Office of Inspector General (“OIG”) recently released a report entitled Questionable Billing Patterns of Portable X-Ray Suppliers (“Report”) wherein it identified portable x-ray suppliers with billing patterns associated with inappropriate Medicare payments. As a result of its Report, the OIG made recommendations to the Centers for Medicare and Medicaid…
As we reported in previous blog entries regarding the 2012 Physician Fee Schedule, the Centers for Medicare and Medicaid Services (“CMS”) will be expanding its application of the Multiple Procedure Payment Reduction (“MPPR”) to the professional component (“PC”) of certain diagnostic imaging procedures. Currently, the MPPR only applies to the…
In its fight against Medicare fraud, HHS announced that it “will direct all Medicare prescription drug plans to use every tool at their disposal to prevent fraud.” HHS noted the increasing problem of doctor shopping, the abuse of OxyContin and Percocet, and prescription drug fraud. Importantly, HHS announced that it…
The Office of Inspector General (“OIG”) has posted its Health Care Fraud Prevention and Enforcement Action Team (“HEAT”) compliance training resources on its website wherein it provides videos and audio podcasts regarding a number of topics, including: An overview of the OIG Overviews of the healthcare fraud and abuse laws;…
In a December 13, 2011 press release, the Department of Health and Human Services (“HHS”) announced that the Department of Justice (“DOJ”) has recovered over $5.6 billion in total fraud in 2011, an increase of over 167% since 2008. Of this $5.6 billion recovered in 2011, over $2.9 billion (over…
On December 7, 2011, the Office of Inspector General (“OIG”) posted a favorable Advisory Opinion 11-18 pertaining to Requestor’s online service that would facilitate the exchange of information between healthcare practitioners, providers and suppliers (“Proposed Arrangement”). Requestor, a publicly traded company, currently provides web-based services that help physicians “achieve faster…
The Medicare and Medicaid Electronic Health Record (“EHR”) Programs incentivize the meaningful use of certified EHR technology to achieve health and efficiency goals. Eligible professionals and hospitals that meet certain requirements using certified EHR technology (i.e., satisfy certain “meaningful use” criteria) will be eligible for incentive payments of up to…
In the November 28, 2011 Federal Register, the Centers for Medicare and Medicaid Services (“CMS”) retracted its requirement that physicians or non-physician practitioners (“NPPs”) sign requisitions for clinical laboratory tests paid under the Clinical Laboratory Fee Schedule (“CLFS”). When it was first enacted ten years ago, in 2001, CMS revised…
Today, CMS held its Open Door Forum related to the CMS A/B Rebilling Demonstration. General information related to the CMS call is available at http://go.cms.gov/cert-demos. This website includes a Frequently Asked Question document, slides related to the call, and the enrollment application. CMS outlines the process for the rebilling demonstration…