Led by a record-breaking legal settlement with drugmaker GlaxoSmithKline, federal collections from civil False Claims Act prosecutions and settlements exceeded all previous years, topping $4.9 billion in the most recent fiscal year. The biggest single chunk–more than $3 billion–came from healthcare companies accused of defrauding Medicare and other government healthcare programs. Fiscal 2012 marked the […]
On November 13, 2012, the American Medical Association (“AMA”) House of Delegates issued new guiding principles for physicians entering into employment and contractual arrangements. The six principles issued by the AMA are intended to provide physicians with guidance as to how to handle potentially problematic aspects of the employer-employee relationship and include addressing: (1) conflicts […]
The Office of Inspector General (“OIG“) has refused to grant a request that Boarded Sleep Physicians be permitted to dispense PAP therapy directly to their own Medicare patients. The OIG’s Semiannual Report to Congress for the period April 1, 2012 – September 30, 2012 (the “Report“) issued on November 27, 2012, contains the following description […]
Washington, DC – The Department of Health & Human Services (HHS) Office of Inspector General (OIG) today announced expected recoveries of about $6.9 billion from audits and investigations in its semi-annual report to Congress. The report focuses on OIG accomplishments for the second half of FY 2012 (April 1, 2012 – September 30, 2012) and […]
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 […]
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