In an Open Letter to health care providers published March 24, 2009, the Office of Inspector General (“OIG”) refined its Self-Disclosure Protocol (“SDP”) to resolve matters giving rise to civil monetary penalties (“CMPs”) under the federal Stark law and Anti-Kickback Statute, initially addressed by way of Open Letter dated April 24, 2006. In order to […]
The American Recovery and Reinvestment Act (the “Act” or “Stimulus Package”) included important changes to the Consolidated Omnibus Reconciliation Act (“COBRA”). Generally speaking, COBRA allows workers who have lost employer-sponsored health insurance to retain coverage for a period of time. The Stimulus Package includes important provisions related to the cost of health insurance premiums. Generally […]
Recovery Audit Contractors (“RACs”), as other Medicare contractors, are authorized to audit only a small sample of a providers’ or suppliers’ records, and if the RACs find an overpayment, they will extrapolate the overpayment finding to the providers’ or suppliers’ patient population. If RACs engage in statistical sampling and extrapolation, RACs are entitled to keep […]
Generally speaking, the Federal Stark law makes it unlawful for a physician to refer Medicare or Medicaid patients for designated health services (“DHS”) to an entity with which the physician (or an immediate family member) has a financial relationship, unless an exception applies. The Federal Stark law applies only to referrals of DHS. Questions can […]
The Michigan Medical Marijuana Program is set to begin April 6, 2009. Beginning on this date, patients may submit an application to participate in the Michigan Medical Marijuana Program. Applicants must have a “debilitating” illness or condition, such as cancer, glaucoma, positive status for human immunodeficiency virus (HIV), acquired immune deficiency syndrome (AIDS), hepatitis C, […]
The Centers for Medicare and Medicaid Services (“CMS”) recently published a final rule addressing termination of non-random prepayment complex medical review, which became effective January 1, 2009. The final rule implements Section 934 of the MMA, which required CMS to establish termination dates for non-random prepayment complex medical reviews performed by Medicare Administrative Contractors (“MACs”), […]
The Medicare Recovery Audit Contractor Program (“RAC”) program has been made permanent and is expanding nationwide, pursuant to Section 302 of the Tax Relief and Health Care Act of 2006. Medicare providers and suppliers in Michigan are some of the first in the country that will experience RAC audits and potential claim denials. Pursuant to […]
The Medicare Recovery Audit Contractor (“RAC”) program is being challenged by the two San Diego, California-based hospitals of Palomar Pomerado Health (“Palomar”). In a complaint filed against the Department of Health and Human Services (“HHS”) on March 27, 2009, Palomar alleged that PRG Schultz International, Inc. (“PRG Schultz”), the RAC operating in California during the […]
A recent Federal appeals court decision paved the way for a whistleblower to proceed with a False Claims Act (“FCA”) case involving allegations of Stark and Anti-kickback Statute violations regarding an exclusive anesthesia coverage agreement and pain management services arrangement. This case is important as it highlights how courts and enforcement officials may apply Stark […]
As part of the OIG 2008 Work Plan, the OIG reviewed Medicare payments for interventional pain management procedures in connection with Section 1862(a)(1)(A) of the Social Security Act, which requires that services must be medically necessary. The OIG noted that interventional pain management was a growing specialty and that Medicare paid almost $2 billion for […]
Health Law Attorney Blog