On June 9, 2010, the Office of Inspector General (OIG) published a report regarding inpatient rehabilitation facility (IRF) payments made in 2006 and 2007. According to this report, over half of the claims reviewed (i.e., 113 out of 200 claims) resulted in overpayments, because the providers failed to submit patient assessment instruments within the requisite […]
On May 28, the Centers for Medicare and Medicaid Services (CMS) issued Transmittal 128, which clarifies CMS policies regarding physician supervision of diagnostic and therapeutic services provided to hospital outpatients. The transmittal, effective on July 1, 2010, updates the Hospital Outpatient Prospective Payment System (OPPS). In the transmittal, CMS specifies that “[d]irect supervision is the […]
On May 26, 2010, CMS published a proposed rule revising the Medicare Conditions of Participation (CoPs) to give hospitals and critical access hospitals (CAHs) more flexibility in credentialing and privileging telemedicine physicians and practitioners (while not prohibiting hospitals from continuing to use traditional credentialing and privileging process if they please). The proposed CAH CoP requirements […]
In a long-anticipated maneuver, the American Medical Association (“AMA”), American Osteopathic Association (“AOA”) and the Medical Society of the District of Columbia (“MSDC”) filed a lawsuit last week seeking to block the Federal Trade Commission (“FTC”) from requiring physician practices to implement its “Red Flag” identity theft safeguards. In an ongoing saga that HLP has […]
It looks like the days of “voluntary” compliance programs are coming to a close. As we discussed in a recent blog, the health care reform bill contained provisions mandating compliance programs. New York providers receiving Medicaid funds have already experienced mandatory compliance obligations as a result of the New York Office of Medicaid Inspector General […]
The Office of the Inspector General (“OIG”) of the Department of Health and Human Services (“HHS”) issued a report this month showing that program safeguard contractors (“PSCs”) have not resulted in significant recoveries to the Medicare program. PSCs are intended to detect and deter fraud and abuse in Medicare, by conducting investigations and, at issue, […]
On April 29, 2010, the U.S. Sentencing Commission issued new amendments to the standards for, and criteria included in, an “Effective Compliance and Ethics Program” in the Federal Sentencing Guidelines. These amendments have important implications for all corporate health care providers. For more information on corporate governance and effective compliance programs, please contact Abby Pendleton, […]
The HIPAA Privacy rule currently provides the right of an individual to receive an “accounting of disclosures,” essentially a listing, of occurrences where a HIPAA covered entity has disclosed the individual’s information to others–but this rule has not considered disclosures made for treatment, payment, and health care operations information that must be included in the […]
Effective May 1, 2010, physicians, IDTFs and other Part B Suppliers furnishing Non-invasive Vascular Testing in Michigan must comply with new training and certification requirements. In part, the policy, as set forth in a new LCD, states: A. Training and Certification 1. The accuracy of non-invasive vascular diagnostic studies depends on the knowledge, skill, and […]
The recently passed health care reform bill–known more technically as the Patient Protection and Affordable Care Act–contains a provision bound to increase enforcement regimes for health care providers. For instance, at Section 6401(a)(7), the Act creates mandatory compliance programs for providers enrolled in Medicare and Medicaid. The Secretary of Health and Human Services is tasked […]
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