The national health care reform, the implementation of which effectively requires a shift of health insurer spending more heavily towards medical care, is projected to reduce insurance profit margins to approximately 3% to 5%. This is a substantial decline considering these margins historically averaged around 7% to 8%. As a result, major health insurers in […]
A Florida radiology clinic, Midtown Imaging LLC, and its former owners–Midtown Imaging PA and PBC Medical Imaging–have agreed to pay $3 million to settle allegations that Midtown Imaging LLC submitted false claims to Medicare between 2000 and 2008. The allegations arose from Midtown Imaging LLC’s lease and professional services agreements with referral sources that were […]
Five U.S. senators requested an investigation by the Inspector General of the Department of Health and Human Services (“HHS”) into the legality of physician-owned distributorships (“PODs”). The legality of the PODs is being questioned under the federal Anti-kickback Statute and other fraud and abuse laws. Distributorships act as a link between medical device manufacturers and […]
June 7, 2011, the Departments of Justice and Health and Human Services (“HHS”) announced that Reynel Betancourt, a 51 year-old Miami resident, was sentenced for his involvement in a $9 million Medicare fraud scheme originating in metro Detroit. His penalty includes 77 months in prison and three years of supervised release. Betancourt was also ordered […]
In February, the Centers for Medicare and Medicaid Services (“CMS”) settled the first Stark matter since the publication of the CMS Voluntary Self-Referral Disclosure Protocol (“SRDP”). Although CMS spokesperson, Ellen Griffith, would not provide additional details, she confirmed that a settlement was reached. According to other sources, however, the first Stark case involved Saints Medical […]
The patient-centered medical home (“PCMH”) concept, in which a primary care physician and an interdisciplinary team coordinate the provision of patient services, continues to gain support. In April, New York State Health Commissioner Nirav Shah, M.D. promoted the state’s new initiative to increase access to PCMHs during his National Public Health Week visit to Urban […]
On May 31, 2011, the Department of Health and Human Services (“HHS”) issued a notice of proposed rulemaking (“Proposed Rule”) in relation to the Health Insurance Portability and Accountability Act (“HIPAA”) Privacy Rule (“Privacy Rule”). The Proposed Rule concerns changes to the accounting disclosures requirement of the Privacy Rule. The Proposed Rule intends to divide […]
On Friday, June 3, the American Medical Association (AMA) submitted its comments to Donald Berwick of the Centers for Medicare and Medicaid Services (CMS) regarding CMS’ proposed rule for Accountable Care Organizations (ACOs). In its opening remarks, the AMA states the following: The AMA is pleased to provide our views and recommendations for revising the […]
CMS has proposed a new rule that would grant organizations that meet certain qualifications access to patient-protected Medicare data, in order to produce public reports on physicians, hospitals and other healthcare providers. These reports would be a combination of Medicare claims data and private-sector claims, identifying which physicians and hospitals provided the highest quality, cost-effective […]
The Centers for Medicare & Medicaid Services (“CMS”) is taking steps in anticipation of its Medicare Part D RAC program release; this component of the RAC program is expected to begin in the third quarter of 2011. The director of the Medicare Program Integrity Group, John Spiegel, announced that CMS selected a vendor for the […]
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