Health Law Attorney Blog

On Tuesday, May 13, 2014, the Department of Justice (“DOJ”) and Department of Health and Human Services (“DHHS”) held a joint news conference to announce that the Medicare Fraud Strike Force had conducted a nationwide takedown of 90 individuals involving approximately $260 million in fraudulent Medicare billings. The nationwide takedown marked the seventh such takedown […]

The final budget bill was recently passed in New York State containing several provisions for Out-of-Network (“OON”) reforms. The major changes related to OON reform include: 1) transparency provisions requiring the reestablishment of “usual, customary and reasonable” or “UCR” charges to determine reimbursement rates; 2) adding protections allowing patients to go OON for specialty care; […]

The Centers for Medicare & Medicaid Services (“CMS”) announced in a Federal Register notice that it is creating a new data-collection program for hospice quality reporting called the Hospice Item Set (“HIS”) System. The HIS System, which is mandated under Section 3004(c) of the Patient Protection and Affordable Care Act of 2010 (“ACA”), establishes a […]

On April 2, 2014, the Centers for Medicare & Medicaid Services (“CMS”) announced its intent to publish data on its payments to individual physicians. Beginning on April 9, 2014, CMS plans to release information regarding the charges for medical services and procedures furnished by physicians and other health care professionals. CMS stated that the data […]

In need of Ethics Credits? ABA members can get them for free by attending, “You Mean HIPAA Applies to Lawyers? Keeping Data Safe, Clients Happy and Your License Secure”, with The HLP’s, Clinton Mikel, Esq., as a Speaker/Moderator, April 21, 2014.

It is customary for insurers to deny claims submitted by no-fault providers, and providers, in turn, commonly challenge these denials. Conversely, it is anomalous for a no-fault provider to initiate a (putative) class action suit in response to an insurer’s payment denials. Yet, in a recently filed action, an aggrieved provider did just that. Pan […]

The Centers for Medicare & Medicaid Services (“CMS”) announced changes to the Medicare Fee-For-Service Recovery Audit Program in a posting on the CMS.gov website February 18, 2014. According to CMS, the changes will go into effect after the new Recovery Audit Program contracts are awarded. The announcement includes changes to the contingency fees paid to […]

Federal authorities are cracking down on abuse of the HITECH Act’s Meaningful Use financial incentive program as evidenced by the recent indictment of Joe White, former CEO of Shelby Regional Medical Center (“Shelby Regional”) in Tyler, Texas. A federal grand jury indicted White on charges of making false statements to the Centers for Medicare and […]