On October 31, 2014, the Department of Health and Human Services (“HHS”) Office of the Inspector General (“OIG”) released its Fiscal Year (“FY”) 2015 Work Plan summarizing its new and ongoing investigative, enforcement, and compliance priorities for the upcoming fiscal year. For FY 2014, the OIG reported recoveries of over $4.9 billion, consisting of nearly […]
In a letter dated December 4, 2014, the American Hospital Association (“AHA”) submitted comments in response to the Office of Medicare Hearings and Appeals (“OMHA”) request for information on current and potential initiatives to resolve the current backlog of appeals at the administrative law judge (“ALJ”) level. In its letter, the AHA takes the position […]
In a letter dated December 3, 2014, the American Medical Association (“AMA”) urged the Centers for Medicare and Medicaid Services (“CMS”) to resolve the two-year backlog of Medicare and Medicaid appeals. The AMA noted that while it appreciated the recent efforts of the Office of Medicare Hearings and Appeals (“OMHA”) to address the issue, the […]
In the December 2014 issue of BCBSM’s The Record, BCBSM reminds pharmacies that the following documents should be available to BCBSM if contacted for an audit in order to avoid preventable findings which could result in significant financial recoupment: Prescriptions. Original prescriptions for written and verbal orders must be submitted by the pharmacy printed copies […]
On November 19, 2014, the House Ways & Means health subcommittee Chair Kevin Brady (R-TX) introduced draft legislation that would revamp the Medicare payment structure for short-term hospital admissions, aiming to resolve the backlog of appeals and to improve the current Recovery Audit Contractor (“RAC”) program. The draft bill–called the Hospital Improvement for Payment (“HIP”) […]
On November 7, 2014, the Professional Services Council (“PSC”), a national trade association of the government technology and professional services industry, filed an amicus brief with the U.S. Court of Appeals for the Federal Circuit to overturn a ruling which would allow Centers for Medicare and Medicaid (“CMS”) to modify payment terms for Recovery Auditor […]
The Health Law Partners, P.C. is proud to announce that various attorneys in the firm contributed healthcare-related articles that were included in the newly-published Fourth Edition of the Legal Manual for New York Physicians, a joint publication of the New York State Bar Association and the Medical Society of the State of New York. The […]
Over the years, there have been attempts to limit the “in-office ancillary services” exception to the physician self-referral law (the “Stark Law”). We have addressed a number of these attempts on our blog (see, for example, Imaging Self-Referrals Could Raise Costs, Hurt Patients, GAO Report Says and Congressional Bill Introduced to Close the In-Office Ancillary […]
On September 30, 2014, the Centers for Medicare & Medicaid Services released the first round of “open payments” data pursuant to the Sunshine Act. Currently, the Open Payments Program lists data on consulting fees, research grants, travel reimbursements, and other gifts the healthcare industry provided to physicians and teaching hospitals during the last five months […]
On October 21, 2014, the U.S. Department of Justice (“DOJ“) announced that two Kentucky-based cardiologists agreed to pay $380,000 to resolve qui tam allegations of purported Stark Law and Anti-Kickback Statute violations (thereby resulting in a False Claims Act violation). The cardiologists purportedly entered into sham management agreements with a hospital in exchange for the […]
Health Law Attorney Blog