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CMS Issues 2012 Final Physician Fee Schedule

CMS Issues 2012 Final Physician Fee Schedule. 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 2012 Final Physician Fee Schedule (“Final Rule”), in part,…

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Yet Again, the SGR Comes Knocking and, This Time, with a 27.4% Cut to Physician Services

The Balanced Budget Act of 1997 enacted the much-despised Medicare sustainable growth rate (“SGR”), which was established to control Medicare spending on physician services. To achieve the SGR target, each year in its report to the Medicare Payment Advisory Commission, the Centers for Medicare and Medicaid Services (“CMS”) includes a…

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Robert S. Iwrey, Esq., Again, Named a d’Business Magazine Top Lawyer in Healthcare in 2012

The HLP is proud to announce that founding partner, Robert S. Iwrey, Esq., was named a d’Business Magazine Top Lawyer in Healthcare for 2012. Iwrey was also named a Top Lawyer in Healthcare in 2010. d’Business polled more than 21,000 attorneys in Oakland, Macomb, Wayne, Washtenaw and Livingston counties, asking…

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DAB Upholds CMS’ Revocation of Provider’s Enrollment for Failure to Timely Report Change in Practice Location

On October 4, 2011 in Izgel Medical Services, PLLC v. CMS, the Department of Health and Human Services Departmental Appeals Board (“DAB”) held that the Centers for Medicare and Medicaid Services (“CMS”) “was authorized to revoke the Medicare provider enrollment of Petitioner, Izgel Medical Services, PLLC” for its failure to…

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CPAP Supplier Agrees to Pay $578,820 for Failure to Use Licensed Respiratory Therapists for PAP Set-Up’s

Premier Home Care, a Durable Medical Equipment company operating in Indiana and Kentucky, agreed to pay a $578,820 settlement with the United States Department of Justice and the State of Indiana in a Whistleblower action alleging violations of the False Claims Act. In 2008, a former employee filed suit against…

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BREAKING NEWS: Final Accountable Care Organization (“ACO”) Regulations Released

The long-awaited final regulations for the Medicare Shared Savings Program (“MSSP”) were released today. The MSSP was implemented by Section 3022 of the Patient Protection and Affordable Care Act and is the program in which ACOs may participate to receive shared savings. In addition to the release of the Final…

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OIG Takes an Unfavorable View of Proposed Pathology Laboratory/Physician Owned LLC Management Services Contract

In the Office of Inspector General (“OIG”) Advisory Opinion 11-15, dated October 11, 2011, the OIG analyzes an arrangement in which Requestor is a Delaware Limited Liability Company owned and managed by a physician (the “Owner/Manager”) which would enter into a management contract with an existing or to be formed…

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Hospice Provider Charged with Defrauding Medicare for More Than $14 Million

In an indictment unsealed on October 12, Matthew Kolodesh (a/k/a “Matvei Kolodech”) was charged with a laundry list of crimes, including 1 count of conspiracy to commit healthcare fraud, 21 counts of healthcare fraud, 2 counts of mail fraud and 11 counts of money laundering of monetary instruments over $10,000.…

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OIG Views Favorably Ophthalmologist-Optometrist Co-Management Arrangement Relative to Cataract Surgery

In the Office of Inspector General (“OIG”) Advisory Opinion 11-14, dated October 7, 2011, the OIG analyzes an arrangement in which Requestor is an opthalmic physician group practice that provides cataract surgeries and also employs optometrists. By way of brief background, generally, patients receiving cataract surgery may elect to have…