The Balanced Budget Act of 1997 enacted the much-despised Medicare sustainable growth rate (“SGR”), which was established to control Medicare spending on physician services. To achieve the SGR target, each year in its report to the Medicare Payment Advisory Commission, the Centers for Medicare and Medicaid Services (“CMS”) includes a…
The Health Law Partners, P.C. is honored to be recognized by the U.S. News as a 2011-2012 “Best Law Firm” in the area of health care law. The rankings showcase law firms ranked nationally in one or more of 75 major legal practice areas. According to a press release issued…
On October 4, 2011 in Izgel Medical Services, PLLC v. CMS, the Department of Health and Human Services Departmental Appeals Board (“DAB”) held that the Centers for Medicare and Medicaid Services (“CMS”) “was authorized to revoke the Medicare provider enrollment of Petitioner, Izgel Medical Services, PLLC” for its failure to…
The long-awaited final regulations for the Medicare Shared Savings Program (“MSSP”) were released today. The MSSP was implemented by Section 3022 of the Patient Protection and Affordable Care Act and is the program in which ACOs may participate to receive shared savings. In addition to the release of the Final…
In the Office of Inspector General (“OIG”) Advisory Opinion 11-15, dated October 11, 2011, the OIG analyzes an arrangement in which Requestor is a Delaware Limited Liability Company owned and managed by a physician (the “Owner/Manager”) which would enter into a management contract with an existing or to be formed…
In an indictment unsealed on October 12, Matthew Kolodesh (a/k/a “Matvei Kolodech”) was charged with a laundry list of crimes, including 1 count of conspiracy to commit healthcare fraud, 21 counts of healthcare fraud, 2 counts of mail fraud and 11 counts of money laundering of monetary instruments over $10,000.…
In the Office of Inspector General (“OIG”) Advisory Opinion 11-14, dated October 7, 2011, the OIG analyzes an arrangement in which Requestor is an opthalmic physician group practice that provides cataract surgeries and also employs optometrists. By way of brief background, generally, patients receiving cataract surgery may elect to have…
By way of Transmittal No. 2316 issued on October 7, 2011, CMS clarified the claims processing procedures for hospice services when a required face-to-face encounter does not timely occur. This clarification creates additional administrative burdens to hospice providers when the required face-to-face encounter does not timely occur. Note that the…
The Centers for Medicare and Medicaid Services (“CMS”), as required by Section 6411 of the Patient Protection and Affordable Care Act (“PPACA”), must annually report to Congress “concerning the effectiveness of the Recovery Audit Contractor program under Medicaid and Medicare and shall include such reports recommendations for expanding or improving…
According to a recent report from the Medical Group Management Association and the Society of Hospital Medicine, hospitalists saw increases in their median compensation in 2010. The report, which is based on survey information from 4,633 hospitalists, found that hospitalists in adult medicine saw their compensation increase 2.6%, while pediatric…