On February 19, 2013, the Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) published OIG Report A-05-11-00071 (the “Report”), detailing the results of an audit to determine the adequacy of CMS’ collection of Medicaid overpayments identified in certain OIG audit reports. Under federal regulations (specifically 42 C.F.R. § 433.304), the Secretary […]
On February 1, 2013, 50-year-old Canton pharmacist, BABUBHAI “Bob” PATEL, was sentenced today to 17 years in prison for his 26 convictions for health care fraud conspiracy, drug conspiracy, and related fraud and drug violations. During his 6-week trial which ended in August 2012, Mr. Patel’s pharmacies were found to have billed Medicare, Medicaid and […]
On January 24, 2013, the U.S. Attorney’s Office for the State of New Jersey unsealed a $12.5 Million Dollar settlement with Cooper Health System, headquartered in the Camden, New Jersey area, but serving regions of New Jersey, Pennsylvania and Delaware. The settlement was the result of cardiologist Nicholas DePace’s whistleblower qui tam lawsuit, which alleged […]
On January 15, 2013, Richard Behnan, DPM., a 56 year old podiatrist from Fenton, MI was sentenced by a federal judge to 55 months in prison and ordered to pay over $1.4 million in restitution to Medicare and nearly $200,000 to BCBSM for his participation in a $1.6 million fraudulent medical billing scheme. Dr.Behnan previously […]
Stay tuned for many further developments – The Health Law Partners will be providing numerous valuable educational resources for its clients. The announcement and links are below. January 17, 2013 The U.S. Department of Health and Human Services (HHS) has announced a new rule to strengthen the privacy and security protections for health information established […]
CMS released Transmittal No. 2634 to update the Medicare Claims Processing Manual in connection with the changes to payment for medical and surgical services furnished by CRNAs. In particular: 140.4.3 – Payment for Medical or Surgical Services Furnished by CRNAs (Rev.2634, Issued: 01-11-13, Effective: 01-01-13, Implementation: 02-12-13) B3-16003.H Payment shall be made for reasonable and […]
According to the US Department of Justice, Florida-based American Sleep Medicine LLC has agreed to pay the government approximately $15,300,000 to resolve allegations that it billed Medicare and other government payors for diagnostic sleep services that were not eligible for payment. The payment settles a qui tam or False Claims Act lawsuit brought against the […]
A press release from the U.S. Department of Health and Human Services (“HHS”) published on January 2, 2013 announced that the Department had reached its first settlement with a covered entity for a breach of the Health and Information Portability and Accountability Act (“HIPAA”) Privacy Rule affecting fewer than 500 individuals. The settlement agreement with […]
As part of the deal to avert the fiscal cliff that was passed on New Year’s Day, Congress extended the 2012 Physician Fee Schedule (“PFS”) through December 31, 2013, effectively freezing implementation of the Sustainable Growth Rate (“SGR”) formula that would have decreased Medicare physician payments by 26.5%. To pay for the cost of the […]
Late in the evening New Year’s Day, the House of Representatives passed a Senate Bill that avoids the fiscal cliff by making middle-class tax rates permanent and postponing automatic spending cuts for two months. As part of the deal, Congress included a Medicare “Doc Fix” necessary to avert a 26.5% cut to Medicare physician payments […]
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