In Advisory Opinion 11-17, the Office of Inspector General (“OIG”) reviewed an arrangement in which a laboratory services management company (“Requestor”) “proposes to provide allergy testing and immunotherapy laboratory services and related items to primary care physicians and physician practices (“Physicians”) within the Physicians’ medical offices. Specifically, Requestor would enter…
The Obama Administration announced that Centers for Medicare and Medicaid Services (“CMS”) Administrator, Donald Berwick, MD, would be stepping down on December 2. His replacement, Marilyn Tavenner, served as Virginia’s Secretary of Health and Human Services from 2006 to 2010 and then served as the CMS Principal Deputy Administrator and…
According to a press release, the Department of Health and Human Services (“HHS”) announced that it will be awarding $9 million from the Centers for Medicare and Medicaid Services (“CMS”) to Senior Medicare Patrol (“SMP”) programs across the country tasked at fighting Medicare fraud. SMP is operated by the Administration…
On November 17, 2011, the Centers for Medicare and Medicaid Services (“CMS”) announced that it will delay enforcement action until March 31, 2012 for those Health Information Portability and Accountability Act (“HIPAA”) covered entities that are not in compliance with the ASC X12 Version 5010, NCPDP Telecom D.0 and NCPDP…
On November 2, 2011, the Centers for Medicare and Medicaid Services (“CMS”) issued a Medicare Learning Network Matters article entitled Autologous Cellular Immunotherapy Treatment of Metastatic Prostate Cancer (“CR 7431”) wherein it “instructs that, effective for services performed on or after June 30, 2011, CMS concludes that the evidence is…
In its November 14, 2011 Order List, the Supreme Court granted certiorari to hear the challenge to the Patient Protection and Affordable Care Act (“PPACA”). Challenges to the law have ranged on issues from the individual mandate, Medicaid expansion, the employer mandate and health benefits exchange. The Court will hear…
The Centers for Medicare and Medicaid Services (“CMS”) defines an overpayment as a payment to a provider or supplier that exceeds the amounts payable under Medicare statutes and regulations. If CMS identifies an overpayment made to a provider or supplier, it will initiate a recovery process for those identified overpayments.…
In August, we posted an entry regarding the newly announced Health Information Portability and Accountability Act of 1996 (“HIPAA”) audits that would be underway, pursuant to Section 13411 of the Health Information Technology for Economic and Clinical Health Act (“HITECH”). Section 13411 provides, in its entirety: SEC. 13411. AUDITS. The…
The Medicare RAC program is expanding even further. By way of a Fact Sheet issued on November 15, 2011, CMS announced three new initiatives with respect to its Medicare RAC program. Beginning January 1, 2012, CMS will conduct demonstration projects with the goal to eliminate fraud, waste, and abuse in…
On July 19, 2011, the Centers for Medicare and Medicaid Services (“CMS”) published in the Federal Register its CY 2012 Physician Fee Schedule Proposed Rule (“Proposed Rule”). On November 1, 2011, CMS issued its CY 2012 Physician Fee Schedule Final Rule (“Final Rule”), in part, to “address changes to the…