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In an audit of Michigan’s Medicaid program, the Office of Inspector General (OIG) found that Michigan’s Medicaid agency did not report on the CMS-64 $3 million in over payments–a direct violation of Section 1903(d)(2) of the Social Security Act (Act). Of that $3 million not reported, $2,198,100 was the federal government’s share. The audit revealed […]

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On October 4, 2010, the OIG released its Work Plan for the FY of 2011. Throughout the week, we will be posting on various aspects of the Work Plan pertinent to our clients and our readers in the following areas: • Hospitals • Home Health Agencies • Hospices • Evaluation and Management Services • Imaging […]

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On September 30, 2010, the Arkansas Supreme Court held that Baptist Health, a private, charitable, nonprofit corporation, may not impose an Economic Conflict of Interest Policy (Policy). In this case, “the Policy mandates the denial of initial and renewed professional staff appointments or clinical privileges at any Baptist hospital to any practitioner who, directly or […]

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Novartis Pharmaceuticals, a US subsidiary of a Swiss pharmaceutical group Novartis, settled with the US Department of Justice (DOJ) for $420 million for allegations of the off-label promotion of Trileptal, submitting false claims because of the unlawful marketing, and paying kickbacks to health care professionals inducing them to prescribe Trileptal and five other drugs. The […]

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On September 28, the Office of Inspector General (OIG) posted Advisory Opinion 10-20 in which it analyzed another pre-authorization arrangement. This is the OIG’s third Advisory Opinion issued this year that favorably reviews the provision of free pre-authorization services to referral sources (please visit our September 9 and May 14 blogs both of which address […]

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Pursuant to our September 11, 2010 blog entry, the FTC is to hold a day-long workshop entitled “Workshop Regarding Accountable Care Organizations and Implications Regarding Antitrust, Physician Self-Referral, Anti-Kickback and Civil Monetary Penalty Laws.” According to the workshop’s website, those who are unable to attend the Baltimore workshop may listen in via webcast. Registration is […]

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As reiterated in the WPS Medicare Part B Legacy eNews, Medicare beneficiaries who elect hospice care, forego their rights to Medicare Part B payments for services related to treating and managing their terminal conditions, unless the services are provided by an attending physician. An “attending physician” is defined as a physician who is a doctor […]

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Health and Human Services (HHS) announced that it launched its new HealthCare.gov Facebook page. According to HHS Secretary, Kathleen Sebelius, “HealthCare.gov on Facebook offers Facebook users a new tool to understand and stay informed about the Affordable Care Act…This new page is another resource that people can use to learn about and discuss health care […]

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On September 22, 2010, the Office of Inspector General (“OIG”) released its Memorandum Report: Questionable Billing for Physician Services for Hospice Beneficiaries addressing a hospice billing vulnerability that cost CMS $566,000 in 2009. The OIG noted that there are instances of billing a single service under both Medicare Parts A and B. Specifically, “physicians may […]

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On September 22, 2010, the House passed HR 6130: Strengthening Medicare Anti-Fraud Measures Act of 2010 (the “Bill”), introduced by Reps. Pete Stark (D-CA) and Wally Herger (R-CA). The Bill provides for an expanded “permissive exclusion from participation in Federal health care programs to individuals and entities affiliated with sanctioned entities.” Summaries of the pertinent […]

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