Due to the high volume of tips and complaints the Department of Health and Human Services (HHS) Office of Inspector General (OIG) receives – approximately 115,000 each year – the need for an efficient means of capturing these complaints was vital for OIG. Released to the public November 14, 2019, the newly redesigned OIG Hotline […]
New York Governor Andrew Cuomo signed legislation on October 17, 2019 further reinforcing New York’s Surprise Medical Bill Law, originally enacted in 2014. That bill, the first of its kind in the nation, is intended to comprehensively protect New York consumers from surprise medical bills for services rendered by out-of-network providers at in-network hospitals. With […]
“We serve patients poorly when government regulations gather dust in the attic: they become even more stale and liable to wreak havoc throughout the health care system. Administrative costs are driving up the cost of health care in America – to the tune of hundreds of billions of dollars. The Stark proposed rule is an […]
By Adrienne Dresevic, Esq. and Carey Kalmowitz, Esq. of The Health Law Partners, P.C. The Centers for Medicare & Medicaid Services (CMS) issued a final rule that strengthens the agency’s ability to stop fraud by barring unscrupulous providers out of federal health insurance programs. This rule is unlike past rules in that it stops providers […]
An Ashland, KY addiction treatment specialist, Dr. Rose O. Uradu, and her substance abuse treatment center, Ultimate Care Medical Services, LLC d/b/a Ultimate Treatment Center, have agreed to pay $1.4 million to resolve civil allegations that they violated the Controlled Substances Act, and defrauded the Medicare and Kentucky Medicaid programs. The settlement resolved a civil […]
On April 8, 2019, the American College of Physicians (“ACP”) released the clinical guideline, “Screening for Breast Cancer in Average-Risk Women: A Guidance Statement from the American College of Physicians” (the “Guideline”). The Guideline divides women into three categories based on age and offers breast cancer screening methodology guidance for each category. The Guideline offers […]
In the recently released CY 2020 Outpatient Prospective Payment System (OPPS) proposed rule, the Centers for Medicare & Medicaid Services (CMS) introduced policies that, if finalized, would require hospitals to post a list of standard charges for items and services provided. This proposed rule updates the requirements set forth in the FY 2015 Inpatient Prospective […]
On July 30, 2019, a federal jury in Detroit, Michigan, found a patient recruiter guilty for his role in a scheme involving approximately $1.3 million in fraudulent Medicare claims for home health care that were procured through the payment of illegal kickbacks. Following a six-day trial, Dominic Trumbo, 45, of Lexington, Kentucky, was found guilty […]
This year, key information regarding the Appropriate Use Criteria (AUC) program is being released by the Centers for Medicare & Medicaid Services (CMS) via guidance documents. A Change Request was issued July 26, 2019, informing Medicare Administrative Contractors (MACs) that they are to begin accepting AUC-related modifiers and healthcare common procedure coding system (HCPCS) codes […]
On July 10, 2019, United States Attorney Matthew Schneider announced the indictment of Dr. Vasso Godiali of Bay City, charged with health care fraud in the amount of $60 million, and money laundering for financial transactions involving approximately $49 million in proceeds derived from the scheme. According to the indictment, Dr. Godiali submitted false and […]
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