Proposed changes to policies and payment rates for services paid under the Medicare Physician Fee Schedule (MPFS) for 2013 were released on July 6. The Centers for Medicare & Medicaid Services (CMS) released the proposed rules and the public is free to comment on the changes throughout a 60-day period that ends September 4, 2012. […]
On June 13, 2012, the California Supreme Court unanimously denied review in the case of California Society of Anesthesiologists v. Superior Court, 204 Cal.App.4th 390 (1st Dist. 2012) ending an over two year battle by the California Society of Anesthesiologists and the California Medical Association who challenged former governor Arnold Schwarzenegger’s certification to the federal […]
Recently, CMS released a related change request (CR) 7838, which informs Medicare contractors about a new addition to the “Medicare Benefit Policy Manual,” Chapter 9, Section 90, which is titled, “Caps and Limitations on Hospice Payment.” A summary of the key provisions of the new Chapter 9, Section 90 of the “Medicare Benefit Policy Manual,” […]
The Government Accountability Office (“GAO”) recently released a Report on the National Medicaid Audit Program (“NMAP”), which found that “private contractors received $102 million to review Medicaid fraud data, yet had only found about $20 million in overpayments since 2008.” In summary, the Report found that compared with initial test audits and more recent collaborative […]
In their June newsletter, The Record, Blue Cross Blue Shield of Michigan (BCBSM) recommended that physicians “consult with their legal counsel periodically.” The problem that BCBSM identified is the situation where physicians prescribe and dispense durable medical equipment and prosthetics and orthotics items in order to provide a means for their patients to be ambulatory […]
On May 18, 2012, Medicare released their 2nd Quarter Newsletter regarding the recovery efforts of each of the region’s Recovery Audit Contractors: DCS, CGI, Connolly, and HDI. CGI Federal has the lowest level of overpayment recoupments and underpayment identification. Connolly and HDI/HMS are identifying and correcting exceedingly more improper payments compared to CGI and DCS. […]
Changes to Recovery Audit Contractor (“RAC”) tracking and reporting of RAC-associated reopenings and appeals data were recently implemented. Specifically, CMS Transmittal 1093, dated May 23, 2012, deleted Business Requirement 7604.2.4, required under Change Request (“CR”) 7469, which mandated specific data transfer protocols related to the information. The Business Requirement was deleted due to RAC-data warehouse […]
The Massachusetts Attorney General’s Office announced Thursday that it has settled, for $750,000, a data breach lawsuit filed against South Shore Hospital under the Massachusetts Consumer Protection Act and the federal Health Insurance Portability and Accountability Act (HIPAA). The alleged HIPAA violation arose from unencrypted back-up tapes that South Shore sent offsite to a data […]
The New York State Department of Financial Services (“Department”) recently issued a highly critical report about out-of-network billing practices in New York State. The report stems from the Department’s receipt of frequent complaints from patients who unexpectedly receive bills from specialists or other providers who they did not know were out-of-network. The Department indicated that […]
The Centers for Medicare and Medicaid Services (“CMS”) has extended the implementation of the Physician Payments Sunshine Act Physician Payments Sunshine Act (“Sunshine Act”), which was promulgated as a result of Section 6002 of the Patient Protection and Affordable Care Act. CMS will not require manufacturers of drugs, devices, biological, or medical supplies to begin […]
Health Law Attorney Blog