In an opinion issued March 30, 2012, the United States Court of Appeals for the Fourth Circuit overturned a $45 million judgment against Tuomey Healthcare System, Inc. (“Tuomey”), a private, nonprofit corporation which owns and operates Tuomey Hospital in Sumter County, South Carolina. A former physician brought a qui tam action against Tuomey alleging that […]
On March 27, 2012, the Office of Inspector General (“OIG”) posted a favorable, but narrowly defined, Advisory Opinion (Opinion No. 12-02) pertaining to Requestor’s proposal to operate a website that would display coupons and advertising from health care providers, suppliers, and other entities (the “Proposed Arrangement”). Under the Proposed Arrangement, the Requestor, a corporation with […]
According to a Department of Justice press release, on Thursday March 15, 2012, a man residing in Dearborn Heights, Michigan was charged by Criminal Complaint with health care fraud. 51-year-old Fitzgerald Anthony Hudson was arrested, and could face a maximum penalty of 10 years imprisonment and a fine of $250,000. Assistant U.S. Attorney Aaron J. […]
In a Study released March 15, 2012, the Department of Health and Human Services, Office of Inspector General (OIG), reported on what it determined to be questionable billing by Independent Diagnostic Testing Facilities (IDTFs) for claims submitted in 2009. In conducting this study, the OIG analyzed claims among geographic areas, identified as Core Based Statistical […]
Medicare released new guidelines regarding the limit on the number of additional documentation requests (“ADRs”) RACs may request per 45-day period. Notably, these revisions constitute an increase for providers. (Note: the revised ADR limits outlined below do not apply to physicians and suppliers.) Effective March 15, 2012, the ADR limits will follow the guidelines bulleted […]
The Acting Administrator of the Centers for Medicare & Medicaid Services (CMS), Marilyn Tavenner, announced the redesign of the statement that informs Medicare beneficiaries about their claims for Medicare services and benefits. The announcement comes as a part of National Consumer Protection Week. The redesigned statement, known as the Medicare Summary Notice (MSN), will be […]
Effective January 1, 2012, Highmark Medicare Services (“Highmark”) was acquired by Diversified Service Options, Inc. (a wholly-owned subsidiary of Blue Cross and Blue Shield of Florida, Inc.). As a result of the acquisition, Highmark changed its name to Novitas Solutions, Inc. (“Novitas”). Novitas will continue Highmark’s role as the Medicare Administrative Contractor (“MAC”) for J12 […]
On February 23, 2012, CMS issued an email notification to all Fee-for-Service (“FFS”) providers, which states the following: CMS has received reports that providers are receiving denials for advanced diagnostic imaging (ADI) services they are accredited to perform. We have taken action to correct the situation. CMS has instructed all contractors to review each ADI […]
In response to concerns raised by the American Physical Therapy Association (APTA) and other associations, the Centers for Medicare and Medicaid Services (CMS) has revised interpretative guidelines (Transmittal 72) to eliminate the requirement that rehabilitation services furnished in outpatient hospital settings be ordered by a practitioner with medical staff privileges. The new guidance issued to […]
Section 6402(a) of the Patient Protection and Affordable Care Act (PPACA) established a new section in the Social Security Act mandating that providers timely report and return Medicare overpayments. Since PPACA’s passage, the healthcare community has awaited clarification on several ambiguities contained in the statute. On February 16, 2012, CMS released a proposed rule implementing […]
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