The Centers for Medicare and Medicaid Services (“CMS”) overpayment recovery through its Recovery Audit Contractor (“RAC”) program is on the rise. CMS recovered in excess of $313 million in Medicare overpayments since October 2009, and almost half of that amount ($162 million) was collected during the first three months of…
The Centers for Medicare & Medicaid Services (“CMS”) recently proposed a rule regarding the hospice wage index for the fiscal year (“FY”) 2012 (“Proposed Rule”). The rule would result in a 2.3 percent increase in Medicare payments to hospices for FY 2012 and implement a new quality reporting system as…
On May 5, the Centers for Medicare and Medicaid Services (CMS) published in the Federal Register its final rule for telemedicine credentialing and privileging for hospitals and critical access hospitals (CAHs). Beginning July 5, 2011, hospitals and CAHs, will have the option of proxy credentialing distant-site physicians and practitioners pursuant…
The Office of Inspector General (OIG) released a report in April entitled Review of Medicaid High-Dollar Payments for Inpatient Services in Michigan from January 1, 2007 Through March 31, 2009 that reviewed whether certain high-dollar Medicaid payments (defined as payments of $200,000 or more) “made to hospitals for inpatient services…
In an effort to better educate the anesthesia community with regard to the impact of Accountable Care Organizations (“ACOs”) on the specialty, the ASA Ad Hoc Task Force on ACOs has been carefully analyzing the March 31, 2011 ACO proposed regulations. As a preliminary step, at the end of April…
Our attorneys are seeing an increase in Medicare claim denials resulting from the lack of valid practitioner signatures. A new publication from the Medicare Learning Network® titled “Comprehensive Error Rate Testing (CERT) Signature Requirements” provides the guidance necessary to avoid such denials. The fact sheet aims to educate health care…
The HLP is proud to announce that the HLP’s founding partner, Adrienne Dresevic, Esq., and former division director at the Centers for Medicare and Medicaid Services (CMS), Donald H. Romano, Esq., co-authored the featured article of the April issue of American Bar Association (ABA)’s The Health Lawyer entitled The “The…
On April 15, CVS Pharmacy, Inc. agreed to pay the United States and 10 states $17.5 million to resolve False Claims Act allegations related to Medicaid billings for prescription drugs. These allegations were introduced to the government by a qui tam whistleblower. According to the Department of Justice press release,…
The Medicare Recovery Audit Contractors (RACs) are introducing another weapon in their artillery: semi-automated claims review. Although semi-automated claims review is not specifically authorized by the RAC Statement of Work, the method is essentially a combination of an automated claims review and a complex claims review. CMS describes a semi-automated…
On February 16, we wrote about a $200 million healthcare fraud scheme in southern Florida in connection with improper billing for Medicare mental health services. In an April 14 Department of Justice press release, the two orchestrators of the fraud scheme–Lawrence Duran and Marianella Valera–pleaded guilty at an arraignment hearing…