The U.S. Department of Health and Human Services recently announced that Medicare Part B premiums (i.e., for physician services, outpatient hospital and durable medical equipment) will rise in 2013 by 5%–to $104.90 a month. The deductible for Part B services will increase from $140 in 2012 to $147 in 2013. Part A premiums (i.e., for […]
More and more physicians are changing from their traditional office-based medical practices to other models of practice that offer them a better quality of life and/or more stable income. One such model is concierge medicine (also known as boutique or retainer medicine). In this model, the physician limits his patient roster to a set number […]
Abby Pendleton, Esq. and Jessica Gustafson, Esq. of the HLP were quoted in the November 12, 2012 issue of Physician’s Money Digest in an article titled “Putting Practices on the RAC”. Pendleton and Gustafson were interviewed based on their experience in defending health care provider audits around the country and their significant involvement in the […]
On November 1, 2012, the Centers for Medicare and Medicaid Services (“CMS”) released a final Durable Medical Equipment (“DME”) face-to-face policy. As a pre-condition to payment, the rule requires that a beneficiary receive a face-to-face encounter with a Physician, Physician Assistant (“PA”), Nurse Practitioner (“NP”), or Clinical Nurse Specialist (“CNP”) within six months prior to […]
In accordance with New York State’s recently enacted accountable care organization (“ACO”) law (Article 29-E of the New York Public Health Law), the New York State Department of Health (“DOH”) will begin to process applications for Medicare-only ACOs to obtain certification under the new statute. The so-called “fast-track certification” under the statute will grant protection […]
On November 19, 2012, Anthony Parkman, RN, was sentenced to serve 30 months in prison followed by 3 years of supervised release and ordered to pay approximately $451,000 in restitution after pleading guilty to one count of conspiracy to commit health care fraud. Nurse Parkman was paid to sign medical documentation for alleged patients of […]
On November 14, the Office of Inspector General (“OIG”) of the Department of Health and Human Services (“HHS”) issued a report stemming from a review of the Administrative Law Judge (“ALJ”) level of the Medicare appeals system. The study analyzed all ALJ appeals decided in fiscal year 2010 from a multitude of perspectives, including interviews […]
Last week, AARP, along with five other consumer and professional organizations, sent a letter to leaders in Congress, urging them to protect access to health care for people with Medicare by addressing the flawed Medicare physician payment formula. Without congressional action, a 27.5 percent cut in payments to physicians treating Medicare beneficiaries will take effect […]
In Advisory Opinion 12-15, issued October 23, the Office of Inspector General (“OIG”) approved a Hospital’s plan to pay specialists on a per diem basis to provide on-call coverage in its Emergency Department (“ED”). Requestor, a tax-exempt, charitable, not-for profit hospital had struggled to fill shortages in its ED for on-call coverage. To meet the […]
Compounding pharmacies have seen increased government investigations in recent years, and are likely to face heightened scrutiny from state and/or federal authorities in the near future. Coupled with heightened scrutiny of health care providers in general, compounding pharmacies should carefully review their operations for compliance with law. Incidents involving providers of compounded medications, most notably […]
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