OIG permitted joint venture of Ambulatory Surgery Center (ASC) by a hospital and LLC. In its Advisory Opinion 09-09 released yesterday, the Office of Inspector General (OIG) analyzed a situation in which a Hospital and an LLC (Surgeon LLC), owned by seven orthopedic surgeons (Surgeon Investors), would jointly own a…
FTC postponed Red Flags. As many entities have been scrambling to get their anti-identity theft programs in place by August 1, the Federal Trade Commission (FTC) announced that it would be pushing back enforcement of the Red Flags Rule until November 1. The purpose of this is to continue to…
Get ready: the Centers for Medicare and Medicaid Services (CMS or Medicare) Recovery Audit Contractor (RAC) program has been made permanent and is expanding nationwide. All Medicare providers and suppliers should begin to prepare now for increased Medicare scrutiny. Hospitals and health systems nationwide can expect RAC auditing activity and…
This article is the second part of a 2 part series addressing recent federal regulatory action targeting diagnostic imaging arrangements. Part 1 (published in the January/February 2009 issue of Radiology Management) focused solely on some of the more significant changes to the federal Stark regulations. Part 2 will summarize some…
In recent years, the diagnostic imaging services industry has been intensively scrutinized by the federal government, as evidenced by heightened regulatory action targeting certain diagnostic imaging arrangements, such as changes to the federal Stark Law (that restrict the flexibility of structuring diagnostic imaging arrangements), expansion of the federal anti-markup prohibition,…
Recent legislative initiatives to restrict (or eliminate) the Stark Law’s In-Office Ancillary Services Exception (IOASE) are by no means a new phenomenon. Rather, over the last few years, the Centers for Medicare and Medicaid Services (CMS) has introduced several significant proposals targeting the provision of diagnostic imaging (and other ancillary…
The Affordable Health Choices Act (Act) has been hotly contested by many Republicans, some Democrats, and now, is being put in place by Congressional Budget Office (CBO). The CBO is the final authority when it comes to the cost of legislation and it announced that the Act is not “budget…
According to the 2010 Proposed Physician Fee Schedule (PPFS), as of January 1, 2012, the Center for Medicare and Medicaid Services (CMS) proposes that Medicare payment be made only for the technical component (TC) of advanced diagnostic imaging services to suppliers who have met the accreditation requirements set forth by…
House Democrats released the long-awaited healthcare bill today. In its 1018 pages, it describes its 10-year, $1 trillion venture that includes the highly controversial government insurance plan. As Democrats have publicized, this bill will greatly expand healthcare insurance coverage to Americans without insurance and, at the same time, slow the…
Wednesday, Michigan’s Attorney General–Michael Cox–alongside Republican legislators supported a bill being drafted by the Michigan legislature that would create a Michigan Office of Medicaid Inspector General (OMIG). This office would convert the already-in-place Medicaid Fraud Control Unit to an office that audits Medicaid activities and helps detect and prevent Medicaid…