On May 24, 2011, the Joint Commission announced that the new Primary Care Medical Home (“PCMH”) option for commission accredited ambulatory care organizations, by which a primary care clinician and an interdisciplinary team render patient services, will launch in July 2011. Applications from entities that are prepared for survey are…
On May 26, the American Medical Association (AMA) submitted a letter to Donald Clark–the Federal Trade Commission (FTC) Secretary–in response to the proposed FTC and Department of Justice (DOJ) Statement of Antitrust Enforcement Policy regarding accountable care organizations (ACOs). The AMA opened its letter by urging the FTC to consider…
Gentiva Health Services, Inc. (Gentiva)–one of the largest providers of home health services in the world–has settled with the government for $12.5 million. The settlement came after allegations that it fraudulently billed Medicare for non-Medicare-covered costs. According to the Department of Justice Press Release, “[a]n investigation established that, through its…
On June 1, the Office of Inspector General (“OIG”), Department of Health & Human Services (“HHS”) announced expected recoveries of $3.4 billion from its legal actions (including investigations and other reviews, totaling about $3.2 billion) and audits (approximately $222 million). Most of the OIG reviews concerned Medicare and Medicaid. The…
Late last month the United States Justice Department announced that Areté Sleep LLC, Areté Sleep Therapy LLC and Areté Holdings LLC (“Areté”) agreed to settle false claims allegations for $650,000. The prosecution contends that from November 2002 to December 2009 Areté’s medical equipment and sleep medicine facilities in Arizona and…
In Zia Hospice v. Sebelius, CV 09-0055 CG/LFG and CV 09-1108 CG/ACT, the New Mexico District Court followed the trend set by numerous other courts, including the 5th and 9th Circuit Courts, in relation to the hospice cap regulation, 42 C.F.R. §418.309(b)(1). The Court held 42 C.F.R. §418.309(b)(1) invalid because…
The Health Law Partners, P.C. (“The HLP”) is pleased to announce a new addition to our growing team of health care lawyers. Attorney Timothy Burkhard, formerly of Foster, Swift, Collins & Smith, P.C. has joined The HLP. Mr. Burkhard focuses his practice on health care business transactions and corporate matters,…
Earlier this month, Transmittals to the State Operations Manual for ASCs (Appendix L) implemented certain clarifications/changes to the anesthetic risk assessment, H&P and pre-surgical evaluation Conditions of Participation at ASCs, effective 5.13.11. The new standards from the Transmittal are set forth below, followed by the provisions in which these new…
According to the Medical Group Management Association (“MGMA”), physicians enjoyed an employee’s market in 2010. Based on MGMA survey data, 56% of first-year physicians accepted paid relocation packages and signing bonuses last year. Also, 12% of first-year doctors obtained loan-forgiveness packages. The MGMA survey also found that first-year specialists in…
In its proposed rule for accountable care organizations (“ACOs”), the Centers for Medicare and Medicaid Services (“CMS”) includes mandatory compliance plans as an element of its ACO-program integrity efforts. The compliance plan must include at least the following elements: • A designated compliance officer who is not legal counsel to…