On July 8, New York Governor Andrew Cuomo nominated James Cox, a former high-level federal auditor, as New York’s new Medicaid Inspector General. The nomination is seen as an important step in increasing New York’s crackdown on Medicaid fraud. Medicaid Fraud has been a major problem for the state of New York and its $53 […]
Medicare beneficiaries are able to obtain power wheelchairs when medically necessary under Medicare Part B. From 1999 to 2003, Medicare saw a 350 percent increase in payments for power wheelchairs. The $900 million jump raised concerns regarding the appropriateness of these Medicare payments. Although the new policies implemented in subsequent years lowered these numbers, Medicare […]
In the recently released Proposed Physician Fee Schedule for calendar year (“CY”) 2012 (“Proposed Rule”), the Centers for Medicare & Medicaid Services (“CMS”) proposes changes to the Electronic Health Record (“EHR”) Incentive Program for eligible professionals (“EPs”). Under the Proposed Rule, CMS proposes the continuation of the attestation method of clinical quality measures (“CQM”) reporting […]
On July 6, 2011, Dr. Leonard Langman, a neurologist who owned and operated a Brooklyn, N.Y. medical clinic, pled guilty to one count of health care fraud for his role in a scheme to defraud Medicare, the U.S. Department of Labor, Office of Workers’ Compensation Programs (OWCP), the New York State Workers’ Compensation Board (NYS-WCB), […]
In recent years, the Centers for Medicare & Medicaid Services (“CMS”) has taken steps to address potentially undervalued and overvalued services under the Medicare Physician Fee Schedule. In the recently released Proposed Physician Fee Schedule for calendar year (“CY”) 2012, CMS specifically addresses payment codes for bone density tests. Since the payment calculation specified by […]
In the recently released Proposed Physician Fee Schedule for calendar year (“CY”) 2012, the Centers for Medicare & Medicaid Services (“CMS”) proposes the addition of new codes to the list of Medicare telehealth services. After reviewing numerous submitted requests, CMS only proposes the addition of smoking cessation services as approved Medicare telehealth services for CY […]
The most recent advisory opinion released by the Centers for Medicare & Medicaid Services (“CMS”), Advisory Opinion No. CMS-AO-2011-01, analyzes the acceptability of a non-competition clause in a proposed physician agreement (“Proposed Agreement”) in light of the Stark Physician Recruitment Exception (42 C.F.R. 411.357(e)). Specifically, the Requestor (or “the Hospital”) inquires whether the Proposed Agreement […]
Section 105 of the Medicare and Medicaid Extenders Act of 2010 (“MMEA”) extended the payment to independent laboratories for the technical component (“TC”) of certain physician pathology services through calendar year (“CY”) 2011 only. In line with section 105, the Centers for Medicare & Medicaid Services’ (“CMS”) Proposed Physician Fee Schedule for CY 2012 revises […]
The Department of Justice announced on June 30, 2011 that a Las Vegas physician, Rakesh Nathu, settled False Claims Act allegations with the United States for $5.7 million plus interest. Nathu allegedly submitted false claims to Medicare, TRICARE and the Federal Employees Health Benefits Plan for various radiation oncology services from 2007 to 2009. Allegations […]
Prior to the passing of section 102(a)(1) of the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 (“PACMBPRA”), the 3-day payment window policy for nondiagnostic services provided prior to admission was rarely applied to wholly owned or operated physician practices. However, the enactment of section 102(a)(1) widened the range […]
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