On January 16, 2014, the Centers for Medicare & Medicaid Services (“CMS”) announced that it will release a national provider Comparative Billing Report (“CBR”) addressing Positive Airway Pressure (“PAP”) Devices and Accessories. CMS is using CBRs as a tool to educate providers about applicable Medicare billing rules in furtherance of its goal to improve the […]
The U.S. Justice Department’s Medicare Fraud Strike Force set record numbers for health care prosecutions throughout the Country in Fiscal Year (FY) 2013. The Medicare Fraud Strike Force is a coordinated team of investigators and prosecutors from the Justice Department, the U.S. Department of Health and Human Services and the FBI who, under the supervision […]
An article in Hospitals & Health Networks (“H&HN”), the flagship publication of the American Hospital Association, quoted HLP attorneys Abby Pendleton and Jessica Gustafson on the effects of Medicare audits on hospitals. The article, published on January 14, 2014, discusses the overwhelming burden on hospitals created by the Medicare audit program and recovery audit contractors […]
February 28, 2014 marks the deadline for eligible professionals (“EPs”) to register and attest to demonstrating meaningful use for the 2013 Medicare Electronic Health Records (“EHR”) Incentive Program. EPs must successfully attest by 11:59 pm ET on February 28 to receive incentive payment for 2013 participation. The Medicare EHR Incentive Program provides incentive payments to […]
In a memorandum to Office of Medicare Hearings and Appeals (“OMHA”) applicants, the Centers for Medicare and Medicaid Services (“CMS”) announced that it will temporarily suspend the assignment of new requests for Administrative Law Judge (“ALJ”) hearings for two years. CMS stated in the memo that the reason for the temporary suspension is the increasing […]
On December 26, 2013, the Department of Health and Human Services (“HHS”) and Adult & Pediatric Dermatology, P.C. (“APDerm”) agreed to settle potential violations of the HIPAA Privacy, Security, and Breach Notification Rules for $150,000. In addition the $150,00 settlement, APDerm will also be required to implement a corrective action plan to correct deficiencies in […]
On January 14, 2014, the Centers for Medicare & Medicaid Services (“CMS”) announced a new policy regarding requests made under the Freedom of Information Act (“FOIA”) on amounts paid to individual physicians under the Medicare program. This notice reverses more than 30 years of prior policy. CMS will now make case-by-case determinations as to whether […]
On December 27, 2013, the Centers for Medicare & Medicaid Services (“CMS”) issued revisions to Chapter 15 of the Medicare Program Integrity Manual. The key clarifications/updates of interest to providers include: • Instructions for processing disclosures of final adverse actions reported by providers and suppliers or law enforcement agencies; • New instructions for the maintenance […]
On December 23, 2013, the Department of Health and Human Services (“HHS”) announced the participation of 123 new Accountable Care Organizations (“ACOs”) in the Medicare Shared Savings Program. This step is intended to further advance Medicare’s goal of providing its beneficiaries with access to high-quality, coordinated care nationwide. The newly established Medicare ACOs include a […]
On December 10, 2013, Minnesota Congressman Erik Paulsen introduced a bill into the House of Representatives that he believes will streamline and enhance the U.S. healthcare delivery system. The bill, entitled the “Diagnostic Imaging Utilization Act of 2013” directs Medicare to develop a system whereby physicians ordering advanced imaging (“AI”) would receive electronic clinical guidance […]
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