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…
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…
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…
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…
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…
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,…
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…
Nearly 4 in 10 office-based physicians are now using an electronic health-record system with a basic level of functions, according to the latest estimates from an annual federal survey, up from about 1 in 3 a year ago. A basic system was defined as an EHR that could be used…
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…
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…