On February 2, 2011, the Centers for Medicare and Medicaid Services (“CMS”) issued its final rule regarding the new provider and supplier enrollment screening criteria for Medicare, Medicaid and Children’s Health Insurance Program (“CHIP”) pursuant to Section 6401(a) of the Patient Protection and Affordable Care Act (“PPACA”). Included in the…
In July, the HEALTH LAW ATTORNEY BLOG reported on five U.S. Senators asking the Office of Inspector General (“OIG”) and the Centers for Medicare and Medicaid Services (“CMS”) to issue guidance on physician owned distributorships (“PODs”) (or, sometimes referred to as physician owned intermediaries (“POIs”)). The OIG and CMS have…
Section 6411 of the Patient Protection and Affordable Care Act (“PPACA”) requires states to establish a Medicaid recovery audit contractor (“Medicaid RAC”) program similar to the existing Medicare RAC program. Like Medicare RACs, Medicaid RACs will be tasked with auditing claims to identify overpayments and underpayments and will be compensated…
The HLP would like to congratulate the following hospitals on being named in the top 14 percent of Joint Commission accredited hospitals based upon 2010 core performance measures reported for heart attack, heart failure, pneumonia, surgical, and children’s asthma: In Michigan: MidMichigan Medical Center Gladwin Gladwin Spectrum Health United Memorial…
This month, the Centers for Medicare and Medicaid Services (“CMS”) published a revised recovery audit contractor (“RAC” or “Auditors”) statement of work (“SOW”) which is, as CMS described, a “contract” between CMS and the Auditors to support CMS in its mission to “reduce Medicare improper payments through the efficient detection…
On August 29, 2011, the Department of Health and Human Services Office of Inspector General (“OIG”) issued Advisory Opinion 11-12 in which an operating division of a non-profit corporation (“Requestor”) was seeking an opinion from the OIG regarding its “proposal to enter into arrangements to provide neuro emergency clinical protocols…
The Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) has issued its monthly Recovery Act Oversight report for July 2011. The report revealed what many already know: audits and investigations are have increased considerably since 2009, the year the American Recovery and Reinvestment Act of 2009…
Wisconsin Physician Services (WPS)–the Part B Medicare Administrative Contractor (MAC) for Iowa, Kansas, Missouri and Nebraska and the Legacy Medicare Carrier for Michigan, Illinois, Wisconsin and Minnesota–regularly conducts Service-Specific Probes (Probes) “to validate potential systematic problems with billing, utilization, and or/documentation of a specific service.” In a recent Probe, 99213–the…
Henry Ford Hospital (“Hospital”), a Detroit teaching hospital, applied for Medicare reimbursement for FY 1991-96 and 1998-99 for “pure research” conducted by its residents. In an opinion dated August 18, 2011, the 6th Circuit held that the federal government is not under an obligation to reimburse teaching hospitals for the…
On September 1, 2011, the Department of Justice, the Department of Health and Human Services (HHS), the FBI and the HHS Office of Inspector General (HHS-OIG) jointly announced that eighteen individuals have been charged in the Eastern District of Michigan for their participation in a series of separate Medicare fraud…