On June 1, the Office of Inspector General (“OIG”), Department of Health & Human Services (“HHS”) announced expected recoveries of $3.4 billion from its legal actions (including investigations and other reviews, totaling about $3.2 billion) and audits (approximately $222 million). Most of the OIG reviews concerned Medicare and Medicaid. The…
Late last month the United States Justice Department announced that Areté Sleep LLC, Areté Sleep Therapy LLC and Areté Holdings LLC (“Areté”) agreed to settle false claims allegations for $650,000. The prosecution contends that from November 2002 to December 2009 Areté’s medical equipment and sleep medicine facilities in Arizona and…
In Zia Hospice v. Sebelius, CV 09-0055 CG/LFG and CV 09-1108 CG/ACT, the New Mexico District Court followed the trend set by numerous other courts, including the 5th and 9th Circuit Courts, in relation to the hospice cap regulation, 42 C.F.R. §418.309(b)(1). The Court held 42 C.F.R. §418.309(b)(1) invalid because…
The Health Law Partners, P.C. (“The HLP”) is pleased to announce a new addition to our growing team of health care lawyers. Attorney Timothy Burkhard, formerly of Foster, Swift, Collins & Smith, P.C. has joined The HLP. Mr. Burkhard focuses his practice on health care business transactions and corporate matters,…
Earlier this month, Transmittals to the State Operations Manual for ASCs (Appendix L) implemented certain clarifications/changes to the anesthetic risk assessment, H&P and pre-surgical evaluation Conditions of Participation at ASCs, effective 5.13.11. The new standards from the Transmittal are set forth below, followed by the provisions in which these new…
According to the Medical Group Management Association (“MGMA”), physicians enjoyed an employee’s market in 2010. Based on MGMA survey data, 56% of first-year physicians accepted paid relocation packages and signing bonuses last year. Also, 12% of first-year doctors obtained loan-forgiveness packages. The MGMA survey also found that first-year specialists in…
In its proposed rule for accountable care organizations (“ACOs”), the Centers for Medicare and Medicaid Services (“CMS”) includes mandatory compliance plans as an element of its ACO-program integrity efforts. The compliance plan must include at least the following elements: • A designated compliance officer who is not legal counsel to…
May 10, 2011, the Miami Lakes, Florida council passed a zoning ordinance requiring pain clinics in its town to obtain a special permit. A pain clinic’s grand opening advertisement featuring the words “pain” and “opiates” put a Miami Lakes councilman in fear of potential pill-mill activity coming to town and…
In order to assist individuals interested in learning more about the fundamentals of health care compliance and help answer questions about what to do when compliance issues arise, the Office of Inspector General recently posted the HEAT Provider Compliance Training slide presentation and written materials which accompany its compliance training…
During late March, the Centers for Medicare and Medicaid Services (“CMS”) proposed a rule regarding Accountable Care Organizations (“ACOs”) and the Medicare Shared Savings Program, which will make payments of shared savings to ACOs (“Proposed Rule”). The Proposed Rule describes the amount of financial risk the participants will face and…