On August 2, 2013, the Centers for Medicare & Medicaid Services (“CMS”) issued its highly anticipated 2014 inpatient prospective payment system (“IPPS”) Final Rule (the “Final Rule”). Within this Final Rule, CMS finalized (1) its new requirements for Medicare Part A coverage of inpatient hospital admissions; and (2) its Part…
On July 29, 2013, the Department of Health and Human Services Office of Inspector General released a memorandum report titled Hospitals’ Use of Observation Stays and Short Inpatient Stays for Medicare Beneficiaries. The report was conducted in response to CMS and others who have raised concerns about hospitals’ use of…
On Monday, July 29, 2013, United States Attorney Carmen M. Ortiz and Susan J. Waddell, Special Agent in Charge of the Department of Health & Human Services, Office of Inspector General, announced that Beth Israel Deaconess Medical Center (BIDMC) has agreed to pay $5.3 million to the federal government to…
On June 24, 2013, the Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) released Advisory opinion 13-07 regarding a proposed rebate program. The OIG ruled that the proposed arrangement would not generate prohibited remuneration under the Anti-Kickback Statute (“AKS”) because it qualified for safe harbor protection…
Due to violations of the privacy and security rules under HIPAA, WellPoint has agreed to pay a $1.7 million penalty to the United States Department of Health and Human Services (HHS). Between October 2009 and March 2010, personal information including names, dates of birth, addresses, Social Security numbers, telephone numbers,…
Yesterday, CMS released a pre-publication proposed rule, Revisions to Payment Policies under the Physician Fee Schedule, Clinical Laboratory Fee Schedule and Other Revisions to Part B for CY 2014 (2013-16547) (the “Proposed Rule”). Among other topics of interest, including proposed revisions to the EHR Incentive Program, the Proposed Rule contained…
The Centers for Medicare & Medicaid Services (CMS) has updated the Appeals of Claims Decisions chapter of the Medicare Claims Processing Manual. The changes will be effective beginning July 23, 2013. The updates were enacted to ensure consistency with provisions of the Final Rule issued December 9, 2009, to improve…
On June 13, 2013, the Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) released Advisory opinion 13-03 regarding a proposed arrangement for clinical laboratory services. The OIG’s ruling on the arrangement was unfavorable, concluding there was potential to generate remuneration prohibited under the anti-kickback statute. THE…
Effective September 1, 2013, Blue Cross Blue Shield of Michigan (BCBSM) will implement a new Prescriber Prescription Block Policy. The policy focuses on protecting patient and public safety. Under the new policy, prescriptions will no longer be payable if: • A provider prescribes drugs that are not medically necessary, may…
On May 9th, the Centers for Medicare and Medicaid Services (CMS) announced the start of a procurement process for new Medicare Fee for Service Recovery Audit Program contracts. The General Services Administration issued a Request for Quotes (RFQ) seeking four A/B Recovery Auditors, one national Durable Medical Equipment auditor and…