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…
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…
On November 14, the Office of Inspector General (“OIG”) of the Department of Health and Human Services (“HHS”) issued a report stemming from a review of the Administrative Law Judge (“ALJ”) level of the Medicare appeals system. The study analyzed all ALJ appeals decided in fiscal year 2010 from a…
Last week, AARP, along with five other consumer and professional organizations, sent a letter to leaders in Congress, urging them to protect access to health care for people with Medicare by addressing the flawed Medicare physician payment formula. Without congressional action, a 27.5 percent cut in payments to physicians treating…
In Advisory Opinion 12-15, issued October 23, the Office of Inspector General (“OIG”) approved a Hospital’s plan to pay specialists on a per diem basis to provide on-call coverage in its Emergency Department (“ED”). Requestor, a tax-exempt, charitable, not-for profit hospital had struggled to fill shortages in its ED for…
Compounding pharmacies have seen increased government investigations in recent years, and are likely to face heightened scrutiny from state and/or federal authorities in the near future. Coupled with heightened scrutiny of health care providers in general, compounding pharmacies should carefully review their operations for compliance with law. Incidents involving providers…
Abby Pendleton, Esq. of The HLP was quoted in “Hospitals Brace for Audits of Short-Stay Admissions”, published November 5, 2012 in Crain’s Detroit Business on-line regarding RAC audit activity. In particular, the story discussed the new Medicare RAC pre-payment program and its impact on short-stay hospital admissions. Pendleton was interviewed…
On October 31, 2012, the United States Government Accountability Office (GAO) released a study detailing the results of a six-year analysis they had conducted regarding self-referral practices of physicians and group practices that own/lease/operate magnetic resonance imaging (MRI) and computed tomography (CT) services. Self-referrals for MRI/CT services are often excepted…
The American Hospital Association (“AHA”) and four hospitals (collectively, the “Plaintiffs”) have filed a lawsuit against the Department of Health and Human Services (“HHS”), alleging that the Centers for Medicare and Medicaid Services (“CMS”, a sub-agency of HHS), through its Medicare RAC Program, has inappropriately refused to pay for Medicare…
On October 11, 2012, The OIG distributed a questionnaire to hospitals that have received Medicare EHR incentive payments for demonstrating meaningful use of its certified EHR technology. This questionnaire is being sent to hospitals that have received incentive payments between January 1, 2011 and March 31, 2012 which amounts to…