As part of the deal to avert the fiscal cliff that was passed on New Year’s Day, Congress extended the 2012 Physician Fee Schedule (“PFS”) through December 31, 2013, effectively freezing implementation of the Sustainable Growth Rate (“SGR”) formula that would have decreased Medicare physician payments by 26.5%. To pay for the cost of the […]
Late in the evening New Year’s Day, the House of Representatives passed a Senate Bill that avoids the fiscal cliff by making middle-class tax rates permanent and postponing automatic spending cuts for two months. As part of the deal, Congress included a Medicare “Doc Fix” necessary to avert a 26.5% cut to Medicare physician payments […]
New York State Governor Andrew Cuomo recently signed into law legislation that provides significant amendments to the state’s law governing accountable care organizations (“ACOs”). The new law became effective on October 3, 2012. New York’s ACO law, enacted in March 2011 as a demonstration program, provided that an entity that wants to operate as an […]
On December 19, 2012, The Office of Inspector General (“OIG”) published an advisory opinion (“OIG AO 12-20“) wherein the agency concluded it will not impose sanctions under the Anti-kickback Statute (“AKS”) on a Hospital (“Hospital”) for its proposal to provide a free electronic interface (“the Interface”) to community physicians and physician practices to allow electronic […]
It seems like every ten years or so the pendulum swings towards or away from physicians seeking employment from hospitals as opposed to heading off on their own or joining existing private physician practices. Over the last few years, the pendulum has swung towards hospital employment. A number of factors have arguably led to this […]
On December 13, 2012, the Centers for Medicare and Medicaid Services (“CMS”) released Transmittal 1104. This Transmittal is a one-time update that provides guidance to contractors on applying the Multiple Procedure Payment Reduction (“MPPR”) to advanced imaging services provided for one beneficiary during one session by multiple providers in the same group practice. This transmittal […]
On December 11, 2012, Hetal Barot, a physical therapy assistant from Westland, Michigan, was sentenced today to serve 30 months in prison followed by 2 years of supervised release after pleading guilty to 1 count of conspiracy to commit health care fraud. She was also ordered to pay $1,336,739 in restitution, jointly and severally with […]
Abby Pendleton, Esq. and Adrienne Dresevic, Esq. were interviewed and featured in the December 4, 2012 issue of Motion Magazine in an article titled, “In Good Health”. The article notes that: the firm’s upward trajectory can be traced, in part, to a “strategic decision” to focus on complex health care matters, according to Dresevic and […]
CMS has posted on its website the latest RAC statistics. The statistics for the 4th quarter of FY 2012 show CMS collected $648 million in alleged overpayments and returned $46.5 million in underpayments. CMS’ report on the total amounts collected and returned from October 1, 2009 through September 30, 2012, indicates that $3.16 billion in […]
On Monday, December 10, 2012, Boris Sachakov, MD, a colorectal surgeon, was sentenced to serve 30 months in prison for Medicare and private insurance fraud for billing for procedures such as hemorrhoidectomies that he never performed. On June 13, 2012, Dr. Sachakov was found guilty by a jury of one count of health care fraud […]
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