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The OIG released Advisory Opinion 10-13 on August 31, 2010, concerning a proposed-arrangement where a hospital would be providing pre-authorization services for diagnostic imaging. Requestor, a non-profit hospital, provides diagnostic imaging services to patients. Because many commercial insurers have begun requiring pre-authorization prior to covering diagnostic imaging services, the hospital has proposed to provide free […]

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Founding partner, Adrienne Dresevic, Esq. was quoted in Kaiser Health News on August 23, 2010 in an article on the recent regulations pertaining to physician disclosure requirements involving imaging machines. Dresevic often writes articles and speaks across the nation about the laws and policies surrounding imaging arrangements. Continue Reading →

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Dr. Sam Smith Hill, III’s 2008 healthcare fraud conviction was affirmed by the 5th Circuit on August 25, 2010 (US v. Hill, No. 09-40749 (5th Cir. Aug. 25, 2010). Found guilty in five counts of healthcare fraud by a jury, Dr. Hill’s indictment alleged that he fraudulently billed Medicaid from 2001 to 2008. Having founded […]

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A bill introduced in the Senate on August 5, 2010 would set forth minimum credentialing standards for medical personnel who “perform or plan” medical imaging or radiation therapy procedures. The Consistency, Accuracy, Responsibility and Excellence (CARE) in Medical Imaging and Radiation Therapy Act, introduced by Sen. Harkin (D-IA) and Sen. Enzi (R-WY) responds to concerns […]

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CMS has issued new guidance expanding on the Fee-for-Service Reimbursement instructions detailed in CR 6960 (which HLP had blogged about here). The earlier change request explained the basic standards stemming from the Section 6404 of the Patient Protection and Affordable Care Act of 2010: services billed more than one year after they were provided would […]

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As HLP reported, in April, CMS requested that the RAC for Region D remove an anesthesia care package it had posted to its website. Now, the issue has been re-posted, with some changes: Under NCCI Edit rules, the anesthesia care package consists of preoperative evaluation, standard preparation and monitoring services, administration of anesthesia, and post-anesthesia […]

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As the Wall Street Journal reported on August 9th, health-insurance companies progressively are initiating programs to equip doctors with high-tech patient records. Even with all of the focus on electronic health records (“EHR”), an estimated 80% of U.S. physicians and 90%of hospitals continue to use paper records. As HLP has discussed in a number of […]

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Attorney General of New York, Andre Cuomo, initiated an investigation into health care credit cards after receiving a substantial number of complaints from consumers who were convinced by doctors and dentists to sign up for them. The investigation will examine the financial incentives providers received from promoting the cards. Subpoenas have already been issued to […]

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On July 30, the OIG released advisory opinion no 10-11 (the “Opinion”) which favorably reviewed a company’s proposal to encourage health care providers to use its online program for scheduling meetings with manufacturer representatives by offering the health care provider an opportunity to select a public charity to which the company would make a monetary, […]

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As the HLP had previously reported, on July 16, the HHS Medicare Fraud Strike Force announced charges against 94 individuals for their alleged participation in schemes that collectively submitted more than $251 million in false claims to Medicare. The charges are based on a variety of schemes including: physical therapy and occupational therapy schemes, home […]

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