CMS released Transmittal No. 2634 to update the Medicare Claims Processing Manual in connection with the changes to payment for medical and surgical services furnished by CRNAs. In particular: 140.4.3 – Payment for Medical or Surgical Services Furnished by CRNAs (Rev.2634, Issued: 01-11-13, Effective: 01-01-13, Implementation: 02-12-13) B3-16003.H Payment shall…
According to the US Department of Justice, Florida-based American Sleep Medicine LLC has agreed to pay the government approximately $15,300,000 to resolve allegations that it billed Medicare and other government payors for diagnostic sleep services that were not eligible for payment. The payment settles a qui tam or False Claims…
A press release from the U.S. Department of Health and Human Services (“HHS”) published on January 2, 2013 announced that the Department had reached its first settlement with a covered entity for a breach of the Health and Information Portability and Accountability Act (“HIPAA”) Privacy Rule affecting fewer than 500…
As part of the deal to avert the fiscal cliff that was passed on New Year’s Day, Congress extended the 2012 Physician Fee Schedule (“PFS”) through December 31, 2013, effectively freezing implementation of the Sustainable Growth Rate (“SGR”) formula that would have decreased Medicare physician payments by 26.5%. To pay…
Late in the evening New Year’s Day, the House of Representatives passed a Senate Bill that avoids the fiscal cliff by making middle-class tax rates permanent and postponing automatic spending cuts for two months. As part of the deal, Congress included a Medicare “Doc Fix” necessary to avert a 26.5%…
New York State Governor Andrew Cuomo recently signed into law legislation that provides significant amendments to the state’s law governing accountable care organizations (“ACOs”). The new law became effective on October 3, 2012. New York’s ACO law, enacted in March 2011 as a demonstration program, provided that an entity that…
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…